Abstract: Background: The transesophageal echocardiogram (TEE) is the standard imaging modality for confirming the presence or absence of patent foramen ovale. There is a causal association between PFO and unexplained stroke. It seems that 3D-TEE can present a high-risk PFO morphological feature, which seems to show more than just being easier to open. Methods: In total 134 consecutive patients with cryptogenic stroke or migraine who had suspected PFO and underwent c-TCD, TTE, and c-TEE were included in this study. TEE confirmed the PFO. The right-to-left shunt (RLS) grade of PFO at rest and abdominal compression Valsalva maneuver was detected by c-TEE. Results: The long diameter of FO (1.74±0.3 vs. 1.60±0.4, P=0.039), the short diameter of FO (1.12±0.3 vs. 1.00±0.3, P=0.036), perimeter of FO (4.62±0.7 vs. 4.22±1.0, P=0.026) and area (1.80±0.8 vs. 1.35±0.8, P=0.05) of the FO were significantly larger in the larger RLS group. The cut-off value calculated by ROC for the diagnosis of high-risk PFO was that the length of the PFO tunnel was 12 mm and Left funnelform combined with multiple exits of left atrial (sensitivity was 92%, specificity was 90%). Conclusions: A larger oval fossa can be more easily activated and cause a large right-to-left shunt. The left funnelform, a longer length of the PFO tunnel, and multiple exits of the tunnel of LA increase the risk of CS in anatomical of PFO respect. TEE can precisely visualize the specific morphological characteristics of PFO. These features on TEE have a strong correlation with CS.

Background:Echocardiography is a clinical feasible method of choice for the quantitative analysis of left atrial appendage (LAA) mechanics in two dimensions. The study was to assess the potential relationship of left atrial appendage (LAA) mechanics parameters and left atrial appendage (LAA) function in patients with non-valvular atrial fibrillation (NVAF) by two-dimensional transesophageal echocardiography.Methods:This study involved 216 patients with Atrial Fibrillation ( 39.4%，woman) who were referred for a clinical indication for transesophageal echocardiography (TEE).Speckle-tracking was used to measure left atrial appendage mechanics (LAA) myocardial strain analysis. Left atrial appendage mechanical dispersions (LAAMD) were defined as the standard deviation (SD) of time to peak positive strain corrected by the R-R interval.Results:The Persistent atrial fibrillation（per-AF）group were older, higher prevalence of stroke, and more frequently suffered from heart failure than the Paroxysmal atrial fibrillation（par-AF）group. The patients with a lower LAAEF had less LAA mechanical dispersion than those with a higher LAAEF (4.82(2.66~6.82) vs 8.31(5.22~11.85) ,p＜0.05).The LAAMD had a significant positive correlation with the LAAEF (r=0.455).The LAAEF and LAAMD having the diagnostic performance (AUC,0.7397,95% CI 0.6692–0.8102, 0.6458, 95%CI 0.5678–0.7239, respectively). Using a LAAEF cut-off value of ＜64.5% and LAA MD cut-off value of ＜6.288%, patients with LAA dysfunction were identified with a sensitivity of 70.45%, 62.96% and specificity of 68.47%, 60.55%, respectively.Conclusions:The data showed that LAAMD was predictors of dysfunction of LAA, but LAAMD was not superior to LAAEF in patients for predictors LAA dysfunction. However, Left atrial appendage mechanical dispersion may showed decreased LAA function before LAA deformation