Abstract: Objective To investigate the diagnostic value of contrast transthoracic echocardiography(c-TTE)plus contrast-enhanced transcranial Doppler(c-TCD)for patent foramen ovale right to left shunt(PFO-RLS). Methods The data of 218 PFO patients were examined with transesophageal echocardiography(TEE), and c-TTE plus C-TCD in the resting state and Valsalva state, to assess its diagnostic value for PFO-RLS. Results The detection rate of PFO-RLS was significantly higher in Valsalva state than in resting state(P<0.05). In both state, the c-TTE plus c-TCD examination showed a higher detection rate than c-TTE(P<0.05)or c-TCD alone(P<0.05). When patients had grade I disease, c-TCD had a higher detection rate than c-TTE(P<0.05), but there was no significant difference in the detection rate when the disease was Grade II or Grade III(P>0.05). In grade I and II cases, c-TTE plus c-TCD showed a higher detection rate than c-TTE(P<0.05)or c-TCD alone(P<0.05), but there was no significant difference in the detection rate between c-TTE or c-TCD alone, or combined examination in grade III cases(P>0.05). Conclusion The Valsalva maneuver which increases the right atrial pressure can significantly improve the detection rate of PFO-RLS. The sensitivity and accuracy of c-TTE plus C-TCD are significantly improved in the diagnosis of PFO-RLS compared with those of c-TTE and C-TCD alone(P<0.05).

Key words: Contrast-transthoracic echocardiography, Contrast-enhanced transcranial Doppler, Patent foramen ovale, Right to left shunt, Combined examination