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ECG-Gated Cardiac CT Angiography Using 64-MDCT for Detection of Patent Foramen Ovale

¹ Department of Radiology, Mayo Clinic and Foundation, 200 First St. SW, Rochester, MN 55905.
² Department of Medicine, Division of Cardiovascular Diseases, Mayo Clinic and Foundation, Rochester, MN.

View larger version (121K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 1 —Photograph of pathologic specimen (cardiac apex to left) shows metal pointer inserted into residual septum primum flap in left atrium. Although this septum primum remnant does not connect through to right atrium to form patent foramen ovale in this case, persistent flap can be seen on ECG-gated MDCT, as shown by current study.

View larger version (162K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2A —CT images through interatrial septum from three different patients show characteristic CT findings of patent foramen ovale. RA = right atrium, LA = left atrium. Coronal oblique image in 44-year-old man shows distinct left atrial flap in expected location of septum primum (black arrow) and a definite jet of contrast material into relatively unopacified right atrium (white arrow).

View larger version (117K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2B —CT images through interatrial septum from three different patients show characteristic CT findings of patent foramen ovale. RA = right atrium, LA = left atrium. Coronal oblique image in 55-year-old man shows well-defined column of contrast material connecting left and right atria between septum primum and septum secundum (paired black and white arrows).

View larger version (124K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 2C —CT images through interatrial septum from three different patients show characteristic CT findings of patent foramen ovale. RA = right atrium, LA = left atrium. Axial image in 65-year-old man shows characteristic appearance of left atrial flap seen on ECG-gated CT (arrow).

View larger version (164K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3A —CT and echocardiographic images from 44-year-old man with patent foramen ovale (PFO). RA = right atrium, LA = left atrium. Coronal oblique CT image shows characteristic findings of PFO with left atrial flap (black arrow), continuous contrast column connecting the left and right atria, and jet of contrast material diffusing out into right atrium (white arrow).

View larger version (123K): [in this window] [in a new window] [as a PowerPoint slide]   Fig. 3B —CT and echocardiographic images from 44-year-old man with patent foramen ovale (PFO). RA = right atrium, LA = left atrium. Still-frame axial oblique echocardiographic image of interatrial septum shows defect (arrows). Cine transesophageal echocardiography images confirmed large (4-mm) PFO with bidirectional shunting.

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