Importance of an adequately performed Valsalva maneuver for detecting a right-to-left shunt indicating foramen ovale reopening.
OBJECTIVES
The purpose of this study was to investigate the importance of an adequately performed Valsalva maneuver for detecting a right-to-left shunt indicating reopening of the functional closure of the foramen ovale.


METHODS
We prospectively analyzed 260 patients (102 women and 158 men; mean age ± SD, 41 ± 19 years; range, 13-83 years) who underwent transesophageal echocardiography and agitated saline injection. Two-dimensional echocardiography, color Doppler imaging, and microbubbles were used to detect right-to-left shunts, and the Valsalva maneuver was performed to determine whether the functional closure of the foramen ovale had reopened.


RESULTS
Transesophageal echocardiography with color Doppler imaging identified a patent foramen ovale in 20 patients: 18 patients with a patent foramen ovale had left-to-right shunts, and 2 patients with atrial septal defects had bidirectional shunts. Both patients with atrial septal defects showed right-to-left shunt microbubbles without and with the Valsalva maneuver, whereas all 18 patients with a patent foramen ovale showed right-to-left shunt microbubbles only after the Valsalva maneuver. Foramen ovale reopening was identified by transesophageal echocardiography in an additional 40 patients with no shunt during rest on agitated saline injection and in whom the right-to-left shunt appeared only after the Valsalva maneuver. The Valsalva maneuver could cause an atrial septal swing, and its sensitivity and specificity were 100%.


CONCLUSIONS
An adequately performed Valsalva maneuver is important for detecting a right-to-left shunt indicating reopening of the functional closure of the foramen ovale.
['Wei|Dongmei|D|', 'Ju|Yi|Y|']
D000293:Adolescent D000328:Adult D000368:Aged D000369:Aged, 80 and over D004452:Echocardiography D005260:Female D054092:Foramen Ovale, Patent D006345:Heart Septal Defects, Ventricular D006801:Humans D008297:Male D008875:Middle Aged D015203:Reproducibility of Results D012680:Sensitivity and Specificity D014636:Valsalva Maneuver D055815:Young Adult
Valsalva maneuver right-to-left shunt foramen ovale transesophageal echocardiography microbubbles vascular ultrasound