Abstract
Purpose
The aim of this study was to investigate the frequency with which interatrial shunts are found during routine coronary computed tomography (CT) angiography and to describe imaging characterizations of patent foramen ovale (PFO), atrial septal defect (ASD), and atrial septal aneurysm (ASA).
Materials and methods
A total of 1081 adult patients were evaluated retrospectively for interatrial shunting; 77 were excluded from the study. CT diagnosis of PFO was defined as (1) a channel-like appearance of the interatrial septum (IAS) and (2) a contrast agent jet flow from the left atrium (LA) to the right atrium (RA). ASD was defined as (1) the IAS resembling a membrane with a hole and (2) a contrast jet flow between the two atria. ASA was identified by detecting a minimum 10-mm protrusion of the LA beyond the IAS into the RA.
Results
Among 1004 patients, 86 patients (8.6%) were diagnosed to have PFO. Another 23 patients (2.3%) had a hole in the IAS and were diagnosed as having ASD: 21 with an ostium secundum-type ASD and 2 with the sinus venosus type. ASA accompanied ASD in three patients.
Conclusion
Electrocardiography-gated CT using the saline-chaser contrast injection technique that is routinely used for coronary arterial imaging can be used to detect interatrial shunts. The technique can also serve as a method for differentiating PFO, ASD, and ASA.
Article PDF
Similar content being viewed by others
Explore related subjects
Discover the latest articles, news and stories from top researchers in related subjects.Avoid common mistakes on your manuscript.
References
Saremi F, Attai SF, Narula J. 64 Multidetector CT in patent foramen ovale. Heart 2007;27:505.
Hoey ET, Gopalan D, Ganesh V, Agrawal SK, Screaton NJ. Atrial septal defects: magnetic resonance and computed tomography appearances. J Med Imaging Radiat Oncol 2009;53:261–270.
Zeina AR, Orlov I, Sharif D, Barmeir E. Detection of atrial septal aneurysm by ECG-gated MDCT. AJR Am J Roentgenol 2006;187:W229–W230.
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984;59:17–20.
Handke M, Harloff A, Olschewski M, Hetzel A, Geibel A. Patent foramen ovale and cryptogenic stroke in older patients. N Engl J Med 2007;357:2262–2268.
Pinto FJ. When and how to diagnose patent foramen ovale. Heart 2005;91:438–440.
Khandheria BK, Seward JB, Tajik AJ. Transesophageal echocardiography. Mayo Clin Proc 1994;69:856–863.
Webb G, Gatzoulis MA. Atrial septal defects in the adult: recent progress and overview. Circulation 2006;114:1645–1653.
Rajiah P, Renapurkar R, Kanne J. Diagnosis of ostium primum defect at multidetector CT in an adult. J Thorac Imaging 2009;24:234–236.
Hidalgo A, Ho ML, Bhalla S, Woodard PK, Biiladello JJ, Gutierrez FR. Inferior type sinus venosus atrial septal defect MR findings. J Thorac Imaging 2008;23:266–268.
Ho ML, Bhalla S, Bierhals A, Gutierrez F. MDCT of partial anomalous pulmonary venous return (PAPVR) in adults. J Thorac Imaging 2009;24:89–95.
Thangaroopan M, Truong QA, Kalra MK, Yared K, Abbara S. Images in cardiovascular medicine: rare case of an unroofed coronary sinus—diagnosis by multidetector computed tomography. Circulation 2009;119:e518–e520.
Hanley PC, Tajik AJ, Edwards WD, Seward JB. Diagnosis and classification of atrial septal aneurysm by two dimensional echocardiography: report of 80 consecutive cases. J Am Coll Cardiol 1985;6:1370–1382.
Mügge A, Daniel WG, Angerman C, Spes C, Khandheria BK, Kronzon I, et al. Atrial septal aneurysm in adult patients: a multicenter study using transthoracic and transesophageal echocardiography. Circulation 1995;91:2785–2792.
Kim YJ, Hur J, Shim CY, Lee HJ, Ha JW, Choe KO, et al. Patent foramen ovale: diagnosis with multidetector CT? comparison with transesophageal echocardiography. Radiology 2009;250:61–67.
Kim YJ, Hur J, Choe KO, Choi BW, Shim CY, Choi EY, et al. Interatrial shunt detected in coronary computed tomography angiography: differential features of a patent foramen ovale and an atrial septal defect. J Comput Asist Tomogr 2008;32:663–667.
Mas JL, Arquizan C, Lamy C, Zuber M, Cabanes L, Derumeaux G, et al. Recurrent cerebrovascular events associated with patent foramen ovale, atrial septal aneurysm, or both. N Engl J Med 2001;345:1740–1746.
Fisher DC, Fisher EA, Budd JH, Rosen SE, Goldman ME. The incidence of patent foramen ovale in 1,000 consecutive patients: a contrast transesophageal echocardiography study. Chest 1995;107:1504–1509.
Attaran RR, Ata I, Kudithipudi V, Foster L, Sorrell VL. Protocol for optimal detection and exclusion of a patent foramen ovale using transthoracic echocardiography with agitated saline microbubbles. Echocardiography 2006;23:616–622.
Siostrzonek P, Lang W, Zangeneh M, Gössinger H, Stümpflen A, Rosenmayr G, et al. Significance of left-sided heart disease for the detection of patent foramen ovale by transesophageal contrast echocardiography. J Am Coll Cardiol 1992;19:1192–1196.
Movsowitz HD, Movsowitz C, Jacobs LE, Kotler MN. Negative air-contrast test does not exclude the presence of patent foramen ovale by transesophageal echocardiography. Am Heart J 1993;126:1031–1032.
Wu CC, Chen WJ, Chen MF, Liau CS, Chu SH, Lee YT. Left-to-right shunt through patent foramen ovale in adult patients with left-sided cardiac lesions: a transesophageal echocardiographic study. Am Heart J 1993;125:1369–1374.
Revel MP, Faivre JB, Letourneau T, Henon H, Leys D, Delannoy-Deken V, et al. Patent foramen ovale: detection with nongated multidetector CT. Radiology 2008;249:338–345.
De Castro S, Cartoni D, Fiorelli M, Rasura M, Anzini A, Zanette EM, et al. Morphological and functional characteristics of patent foramen ovale and their embolic implications. Stroke 2000;31:2407–2413.
Roxas-Timonera M, Larracas C, Gersony D, Di Tullio M, Keller A, Homma S. Patent foramen ovale presenting as platypnea-orthodeoxia: diagnosis by transesophageal echocardiography. J Am Soc Echocardiogr 2001;14:1039–1041.
Author information
Authors and Affiliations
Corresponding author
About this article
Cite this article
Kosehan, D., Akin, K., Koktener, A. et al. Interatrial shunt: diagnosis of patent foramen ovale and atrial septal defect with 64-row coronary computed tomography angiography. Jpn J Radiol 29, 576–582 (2011). https://doi.org/10.1007/s11604-011-0602-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11604-011-0602-x