OP-021 DIAGNOSIS OF PATENT FORAMEN OVALE USING CONTRAST TRANSCRANIAL DOPPLER AND TRANSESOPHAGEAL ECHOCARDIOGRAPHY VS CONTRAST-ENHANCED DYNAMIC MRI

2010 ◽  
Vol 140 ◽  
pp. S6
Author(s):  
Ahmet Hakan Ates ◽  
Banu Evranos ◽  
Sercan Okutucu ◽  
Hikmet Yorgun ◽  
Kudret Aytemir ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Dynamic Mri ◽  
Foramen Ovale ◽  
Contrast Enhanced

scholarly journals Transcranial Doppler for patent foramen ovale screening: is there a good correlation with transesophageal echocardiography?

2008 ◽  
Vol 66 (4) ◽  
pp. 785-789 ◽  
Author(s):  
Marcos Christiano Lange ◽  
Viviane Flumignan Zétola ◽  
Admar Moraes de Souza ◽  
Élcio Juliato Piovesan ◽  
Juliano André Muzzio ◽  
...  
Keyword(s):  
Positive Predictive Value ◽  
Transcranial Doppler ◽  
Predictive Value ◽  
Screening Test ◽  
Patent Foramen Ovale ◽  
Foramen Ovale ◽  
Negative Results ◽  
Contrast Enhanced ◽  
Group 2 ◽  
Group 1

Right-to-left shunt (RLS) can be identified by contrast-enhanced transcranial Doppler (cTCD) in patent foramen ovale (PFO) patients. AIM: To evaluate cTCD for PFO screening comparing it to cTEE. METHOD: 45 previous cTCD performed for PFO diagnosis and correlated its findings with cTEE. Patients were submitted to a cTCD standardized technique and were divided in two groups according to RLS: Group 1, patients with a positive RLS and Group 2 when RLS was negative. RESULTS: 29 (65%) patients were included in group 1 and 16 (35%) in group 2. PFO confirmation by cTEE was performed in 28 (62%) patients. cTCD had a 92.85% sensitivity, 82.35% specificity, 89.65% positive predictive value and 87.5% negative predictive value when compared to cTEE for PFO diagnosis. CONCLUSION: Standardized technique cTCD allows for RLS visualization in PFO patients with a good correlation with cTEE and can be used as a screening test before cTEE.

scholarly journals Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

2012 ◽  
Vol 70 (8) ◽  
pp. 578-582 ◽  
Author(s):  
Laura Nicoleti Zamproni ◽  
Viviane Flumignan Zétola ◽  
Marcos Christiano Lange
Keyword(s):  
Antiphospholipid Syndrome ◽  
Transcranial Doppler ◽  
High Intensity ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Stroke Group ◽  
History Of

OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

scholarly journals Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

2019 ◽  
Vol 67 (2) ◽  
pp. 93-102
Author(s):  
Krzysztof Dziewiatowski ◽  
Piotr Siermontowski
Keyword(s):  
Left Atrium ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Decompression Sickness ◽  
Adult Population ◽  
Venous Blood ◽  
Arterial System ◽  
Foramen Ovale ◽  
Contrast Enhanced

Abstract Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

scholarly journals Diagnosis of Patent Foramen Ovale: The Combination of Contrast Transcranial Doppler, Contrast Transthoracic Echocardiography, and Contrast Transesophageal Echocardiography

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Xiaoxue Yang ◽  
Hua Wang ◽  
Yajuan Wei ◽  
Nina Zhai ◽  
Baomin Liu ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Large Sample Size ◽  
Foramen Ovale ◽  
Practical Strategy ◽  
First Choice ◽  
Nonsignificant Difference

Objectives. To access the distinct values of contrast transcranial Doppler (cTCD), contrast transthoracic echocardiography (cTTE), and contrast transesophageal echocardiography (cTEE) in the diagnosis of right-to-left shunt (RLS) due to patent foramen ovale (PFO) and to define the most practical strategy for the diagnosis of PFO. Methods. 102 patients with a high clinical suspicion for PFO had simultaneous cTCD, cTTE, and cTEE performed. The agitated saline mixed with blood was used to detect right-to-left shunt (RLS). Results. In all 102 patients, the shunt was detected at rest by cTCD in 60.78% of cases, by cTTE in 42.16%, and by cTEE in 47.06%. The positive results of all 3 techniques with Valsalva maneuver (VM) were significantly improved. cTCD showed higher pick-up rate than cTTE (98.04% vs. 89.22%; χ2=12.452, p<0.05) and the cTEE (98.04% vs. 96.08%; nonsignificant difference) in the diagnosis of PFO. Nevertheless, cTEE, compared with cTTE, underestimated shunting in 44% of patients. The diameter of both PFO entrance and exit was significantly greater in patients with a severe shunt compared with a mild shunt (2.8±1.0 mm vs. 2.0±0.7 mm, t=3.135, p<0.05; 2.2±0.7 mm vs. 1.6±0.4 mm, t=−2.582, p<0.05). There was a nonsignificant difference in tunnel length between patients with mild shunting and severe shunting(9.3±2.7 mm vs. 9.4±2.9 mm; t=1.358, p>0.05). Conclusions. The best method to diagnose PFO should be the combination of cTCD, cTTE, and cTEE. And cTCD should be applied as the first choice for screening RLS. Then, cTTE should be performed to quantify the severity of the shunt. Last but not least, cTEE should be performed to assess the morphologies of PFO when the closure is planned. The study provides for clinicians the most practical strategy for diagnosing PFO in the future. However, further trials with a large sample size are required to confirm this finding.

scholarly journals Paradoxical emboli: Clinical importance of transcranial doppler for detection of patent foramen ovale

2010 ◽  
Vol 63 (7-8) ◽  
pp. 445-449
Author(s):  
Zeljko Zivanovic ◽  
Svetlana Ruzicka-Kaloci ◽  
Aleksandar Jesic ◽  
Biljana Radovanovic ◽  
Aleksandra Lucic-Prokin ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Contrast Echocardiography ◽  
Cryptogenic Stroke ◽  
Transcranial Doppler Sonography ◽  
Foramen Ovale ◽  
Predictive Values ◽  
Bubble Test

A patent foramen ovale has been reported to be more frequently detected in cryptogenic stroke, with paradoxical embolism as the major pathogenetic mechanism. The standard procedure for the detection of a patent foramen ovale is transesophageal echo?cardiography. Transcranial Doppler sonography with bubble test is almost as reliable as transesophageal echocardiography. Seventeen patients with acute ischemic stroke and transient ischemic attacks hospitalized at the Department of Neurology in Novi Sad underwent examinations to detect a patent foramen ovale, which was found in 55.6% of patients with cryptogenic stroke. The average age of these patients was 30.6 years. Transcranial Doppler sonography showed 100% sensitivity and 100% specificity for the predicti?on of right-to-left shunts proven by transesophageal contrast echocardiography. Both positive and negative predictive values in our group of patients were 1. Transcranial Doppler with bubble test is a reliable method for the detection of a patent foramen ovale, with a high level of sensitivity and specificity which is comparable with transesophageal echocardiography. Moreover, it is cheaper and more comfortable than transesophageal echocardiography, and should be used routinely in neurological practice.

scholarly journals Comparison of Transthoracic Echocardiography, Transesophageal Echocardiography, and Transcranial Doppler in the Detection of Patent Foramen Ovale as the Etiology for Cryptogenic Stroke

2018 ◽  
Vol 35 (2) ◽  
pp. 127-133
Author(s):  
Madison B. Stafford ◽  
Jennifer E. Bagley ◽  
Dora DiGiacinto
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Gold Standard ◽  
Patent Foramen Ovale ◽  
Doppler Sonography ◽  
Cryptogenic Stroke ◽  
Transcranial Doppler Sonography ◽  
Young Patients ◽  
Foramen Ovale

The correlation between cryptogenic stroke and patent foramen ovale is high in young patients. Currently, transesophageal echocardiography is the gold standard for detection. However, it is invasive and limits Valsalva maneuvers. This article reviews the diagnostic accuracy of the three modalities: transthoracic echocardiography, transesophageal echocardiography, and transcranial Doppler. The results suggest that transcranial Doppler sonography is an accurate, easily accessible procedure for detecting patent foramen ovale and should be considered an excellent alternative to transthoracic or transesophageal echocardiography. Transesophageal echocardiography is still necessary for patients who require treatment. The combination of transcranial Doppler and transesophageal echocardiography provides the highest level of information regarding the complete diagnosis of patent foramen ovales.

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