P715Clinical indications for transoesophageal echocardiography in a district general hospital and the prevalence of patent foramen ovale in patients investigated for source of embolus. 11 year data.


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Abstract

Background: The number of transoesophageal echocardiograic (TOE) referrals has significantly increased over the years. One of the commonest indications for the test is to outrule an intracardiac source of embolus (SOE), followed by better evaluation of aortic and mitral valves.Methods: We retrospectively analysed data on all patients who underwent a TOE between May 1998 – May 2009. Our aim was to determine the indications for TOE in a District General Hospital and to determine the incidence of patent foramen ovale (PFO) in our patients referred with a suspected intracardiac source of embolism (SOE). PFO's are routinely sought in all patients irrespective of the indication for TOE.Results: In between May 1998 – May 2009, 2671 patients had a TOE. Mean age of these patients was 63 years (range 15-98), and 58% were male. 563 (21%) patients were referred to outrule an intracardiac SOE, 19% for better evaluation of aortic valve, 15% for better assessment of mitral valve, 12.5% with suspected bacterial endocarditis. Other indications included aortic dissection, intracardiac shunt, thrombus or masses in the atria or ventricles. Of the 563 patients referred with a question of SOE, a PFO was detected in 101 (18%) patients. Mean age of patients referred for assessment of SOE was 55 years, 51% were males and 49% females. n total, 215 of 2671 (8%) patients were diagnosed with a PFO. The mean age of all PFO positive patients was 59 years, 53% were males. The most common indication for TOE in PFO positive patients was SOE (47%), of which 78 % were referred with a history of cryptogenic stroke, 6% with peripheral emboli and 4% included other causes of stroke. A PFO was detected by colour flow Doppler in 63% of these patients, bubble study with agitated saline in 73%, and using the valsalva manoeuvre in 21%. 81% of patients with positive colour flow across the interatrial septum had 1 jet, 8% had 2 jets and 3% had 3 jets noted on CFD. The interatrial septum was aneurysmal with at least a 10mm excursion in 14% of all PFO positive patients.Conclusion: SOE, especially in patients cryptogenic stroke is the commonest indication for performing a TOE in our institution. PFO was found in 8% of all patients irrespective of referral reason and in 18% of SOE patients. However, the recent literature would suggest that invasive management of a PFO is rarely indicated. Referring physicians need to be made aware of the changing recommendations of the management of patients with PFO's which would allow better use of precious health resources.

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