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Forum Name: Congenital Heart Disease in Adults

Question: PFO and TEE


 vickisun - Wed Jun 04, 2003 12:00 pm

March 9, 2003 my 30 yr old son had a stroke. A TEE was performed and 2 doctors saw the PFO and what they think is a Fibroelastoma. My son has recovered totally from the stroke and is currently on Coumaden. A second TEE was performed yesterday by a different doctor and he didn't see the PFO at all nor the fibroelastoma. The doctor said that my son may not need open heart now. He is going to discuss it with the hospital heart board and get back to us. I said, but how could there not be a PFO now when there was one before. He said PFO's often do this. I cannot find any info on this subject of seeing a PFO one time and not seeing another time doing a TEE. We have to wait over a week to get more information so I thought you could help me.
Thank You,
Vicki
 Dr. Yasser Mokhtar - Sun Jun 08, 2003 10:31 pm

User avatar Dear Vicki,

Thank you very much for using our website.

A pfo is an unlcosed connection between the right and left sides of the heart.

A pfo is usually discovered when a something called a "contrast tee or the bubble test" is done and this is usually done by using agitated fluid that when injected into the veins appears in the right side of the heart as bubbles.

Normally, bubbles this size should not pass to the left side of the heart through the lungs and can not pass to the left side spontaneously because normally there is no connection between the two. If a certain number of the bubbles appears in the left side of the heart this usually suggests the presence of a pfo. Some pfos allow blood to pass all the time. Some allow the blood to pass only if the pressure in the right side of the heart is higher than the left and this happens when a person coughs, sneezes, strains, blows his nose, etc... And some allow the bloos to pass sometimes without high pressure and sometimes with high pressure.

A color dopler can also be used during tee to identify the pfo if big enough.

Tee and many other procedures depend on the operator. If a different operator is the one that did the tee in the 2nd time this could be the cause in not seeing the pfo. Or if the bubble test was not performed or if your son was not asked to strain during injection of the fluid to increase the pressure in the right side of the heart.

About the fibroelastoma, on which side of the heart was it identified, right or left? and how big it was? i can not tell for sure and i am not really sure if anybody can really tell if a mass that was identified on tee is a certain tumour and this tumour is a fibroelastoma. Most of the people would say that this is a mass. It could be a blood clot although a blood clot has different characteristics than tumours and usually easily identified as a blood clot and a tumour is usually said to a tumour and most probably a tumour of this or that kind.


Disappearance of a mass from an echo means either it was there and then went away or was not there from the begining and i can not be the judge of that. But if it was there and then disappeared then the diagnosis of a fibroelastoma i think at that time should be doubted and another diagnsois considered.

If there is any doubt about the absence or the presence of a mass in the heart and what it is, i think the best choice is to go for an mri of the heart and i think this will be a little bit hard because there are not so many radiologists out there that could really read one.

Once more, thank you very much for using our website http://doctorslounge.com and i hope that this information helped.

Yasser Mokhtar, M.D.

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