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Old 05-05-2005, 10:41 AM   #1
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Post PFO Diagnosis and TEE Report

(The previous thread had all kinds of bad text wraps which an edit would not allow me to fix.)

I wanted to share with everyone the details of my initial cardiologist examination to the diagnosis of my PFO via a TEE (TransEsophageal Echocardiogram) - I think this might give some insight for some newbies into what these kind of exams are all about:

Quote:
Originally Posted by Initial Examination
HISTORY
The patient is a 33-year old man under the care of Dr. XXX. The patient has heart murmur which was evaluated via echocardiogram performed 10/15/04 at XXX and read by Dr. XXX as suggestive of possible atrial septal defect. The patient is now being admitted for outpatient transesophageal echocardiogram to further evaluate the finding.

He reports that he has been told by Dr. XXX that blood pressure is elevated. Patient feels that this represents "white coat hypertension". Patient's blood pressure taken at home has been normal.

The patient has been in good health. He takes no medications. He does not smoke cigarettes. There have been no hospitalizations and no surgeries. He has had mildly elevated blood pressure. He does 40 minutes of aerobic exercise daily without symptoms.

EXAM
Heart rate 72. Blood pressure 156/90.
Peripheral pulses are of good quality and bilaterally equal.
No caratoid bruit is heard. Venous pressure is not elevated.
Neck is supple. There is no thyromegaly or adenopathy.
There is good air exchange bilaterally. Lungs are clear to percussion and auscultation.
Precordium is quiet without lift, heave, thrill or bulge. There is a Grade II systolic ejection murmur at the upper left sternal border with some radiation to the apex. The murmur varies with respiration, but not with position.
Abdomen is soft and nontender. Bowel sounds are normal. There is no hepatosplenomegaly. No masses are palpable.
There is no edema.

IMPRESSION
1. Possible atrial septal defect.

DISPOSITION
Patient to have transesophageal echocardiogram, to be performed by Dr. XXX. The patient has been advised of the reasons for performing the study and of alternative management. He appears to understand the discussion.
Quote:
Originally Posted by TEE
ANESTHESIA
Local anesthesia with Hurricane spray and intravenous sedation with Demerol and Versed.

DETAILS OF PROCEDURE
Patient had signed the informed consent. He came to the GI Laboratory after a light breakfast in the morning. He had an IV started in his right arm. He was placed on oxygen at two liters by nasal cannula, continuous pulse oximetry, periodic blood pressure check, and continuous EKG monitoring throughout the procedure.

The posterior pharynx was anesthesized with Hurricane spray. The patient was made to lie down in the left lateral position. He received 1 mg of IV Versed and 12.5 mg of Demerol IV.

The Acuson multiplane transesophageal transducer was next advanced into the posterior pharynx and into the upper, mid, and lower esophagus.

Echocardiographic pictures were obtained by gently rotating the transducer in clockwise and anti-clockwise manner as well as flexing and antiflexing the tip to get optimum pictures. Color doppler study was also recorded.

Agitated saline was injected to review the contrast echocardiogram. The superior vena cava and pulmonary artery as well as descending thoracic aorta were visualized. At the end of the procedure, the transducer was withdrawn.

The patient tolerated the procedure well. His vital signs remained stable. He was discharged to the Recovery Room without incident.

FINDINGS
Technically excellent study. All the chambers of the heart were recorded. A small amount of patent foramen ovale was determined with a minimal amount of left to right shunting across the foramen ovale. This was classically laminar flow. Some negative contrast was also noted along the interatrial septum. This appeared to be coming from the superior vena cava. The tricuspid valve was competent. The left heart structures were completely normal. There was no evidence of mitral insufficiency. The left atrial cavity was free of any thrombi. The left atrial appendage was normal. Left ventricular contractility was normal. Right heart structures were unremarkable as well. The pulmonic valve was recorded and was normal. There was no evidence of intraventricular shunting. With Valsalva, there was no evidence of paradoxical shunting
across the interatrial septum. There was no pericardial effusion noted.

CONCLUSION
MILDLY ABNORMAL TRANSESOPHAGEAL ECHOCARDIOGRAM SHOWING PATENT FORAMEN OVALE WITH MINIMUL LEFT TO RIGHT SHUNT. NO DEFINITE ATRIOSEPTAL DEFECT COULD BE IDENTIFIED. MITRAL, TRICUSPID, PULMONIC, AND AORTIC VALVES WERE NORMAL. LEFT VENTRICULAR CONTRACTILITY WAS NORMAL. NO EVIDENCE OF INTRACAVITARY THROMBI OR VEGETATIONS.

 
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Old 05-05-2005, 12:05 PM   #2
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Re: PFO Diagnosis and TEE Report

Hi, i had replied to your previous post "complication free PFO" but you didn't respond. I see you results today. Are you symptom free? Also i noticed that it indicated that there was no definate atrial septal defect (hole). I have an actual hole so they tell me i have an ASD. I wasn't sure if a PFO was the same as an ASD? or is the ASD located in the PFO? Your study looked the same as mine in presentation as far as what they were lookin for but because i have the hole, i also have the left to right shunting and the right sided heart enlargement and increased pulmonary pressures as well as tricuspid damage. They told me these were all indications that surgery was needed. Although if they are able to monitor it over time then apparantly it doesn't get to the point of were mine is. Guess i am not really sure of what just PFO on it's on really is, can it develope into an ASD (hole)? I know it is closley related to PFO in some form. You never mentioned how you felt about this test? Are they going to monitor it? Thanks for the imput and hope your well.

 
Old 05-05-2005, 12:19 PM   #3
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Re: PFO Diagnosis and TEE Report

Sorry to post so soon again but i was reading over your history and notice that it was your heart murmer that lead them to investigate but you had no symptoms. i always had a heart murmer even as a child but they told me it was most likely an innocent one and many people have them with no complications. When i read up on ASD's i can see that many had heart murmers in the same area as yours and mine. Hopefully yours is the innocent type and that they can monitor it in the future.

 
Old 05-05-2005, 12:21 PM   #4
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Join Date: Apr 2005
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mghealth HB User
Re: PFO Diagnosis and TEE Report

Quote:
Originally Posted by born2bwild
Hi, i had replied to your previous post "complication free PFO" but you didn't respond. I see you results today. Are you symptom free? Also i noticed that it indicated that there was no definate atrial septal defect (hole). I have an actual hole so they tell me i have an ASD. I wasn't sure if a PFO was the same as an ASD? or is the ASD located in the PFO? Your study looked the same as mine in presentation as far as what they were lookin for but because i have the hole, i also have the left to right shunting and the right sided heart enlargement and increased pulmonary pressures as well as tricuspid damage. They told me these were all indications that surgery was needed. Although if they are able to monitor it over time then apparantly it doesn't get to the point of were mine is. Guess i am not really sure of what just PFO on it's on really is, can it develope into an ASD (hole)? I know it is closley related to PFO in some form. You never mentioned how you felt about this test? Are they going to monitor it? Thanks for the imput and hope your well.
PFO is not the same as ASD: an ASD is an actual hole whereas a PFO is more like a tear or overlapping flap of tissue with a non-round opening. Yes - I have no symptoms because it's a clinically insignificant PFO. Approximately 25% of the population has PFOs and don't know it. Typically, like in my case, it's complication-free.

PFO: [url]http://www.emedicine.com/med/topic1766.htm[/url]
ASD: [url]http://www.emedicine.com/ped/topic171.htm[/url]

The only similarity that a PFO has to an ASD is that it's located in the same general area: between the left and right atrium of the upper heart.

Last edited by mghealth; 05-05-2005 at 12:22 PM. Reason: Typos

 
Old 05-05-2005, 12:54 PM   #5
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Join Date: Apr 2005
Posts: 49
born2bwild HB User
Re: PFO Diagnosis and TEE Report

Thanks for the clarification, i could see that they were looking for a possible ASD in your case. I see the link now. Thanks again.

 
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