Transcranial Doppler Quantification of Residual Shunt after Percutaneous Patent Foramen Ovale Closure: Correlation of Device Efficacy with Intracardiac Anatomic Measures

Introduction: Interatrial communication is associated with an increased risk of decompression sickness (DCS) in scuba diving. It has been proposed that there would be a decreased risk of DCS after closure of the interatrial communication, i.e., persistent (patent) foramen ovale (PFO). However, the clinical evidence supporting this is limited. Methods: Medical records were reviewed to identify Swedish scuba divers with a history of DCS and catheter closure of an interatrial communication. Thereafter, phone interviews were conducted with questions regarding diving and DCS. All Swedish divers who had had catheter-based PFO-closure because of DCS were followed up, assessing post-closure diving habits and recurrent DCS. Results: Nine divers, all with a PFO, were included. Eight were diving post-closure. These divers had performed 6,835 dives (median 410, range 140–2,200) before closure, and 4,708 dives (median 413, range 11–2,000) after closure. Seven cases with mild and 10 with serious DCS symptoms were reported before the PFO closure. One diver with a small residual shunt suffered serious DCS post-closure; however, that dive was performed with a provocative diving profile. Conclusion: Divers with PFO and DCS continue to dive after PFO closure and this seems to be fairly safe. Our study suggests a conservative diving profile when there is a residual shunt after PFO closure, to prevent recurrent DCS events.

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Residual Shunt after Patent Foramen Ovale Device Closure in Patients With Cryptogenic Stroke: Serial Bubble Contrast Transesophageal Echocardiography Data

Journal of Stroke and Cerebrovascular Diseases ◽

10.1016/j.jstrokecerebrovasdis.2018.10.006 ◽

2019 ◽

Vol 28 (2) ◽

pp. 347-353 ◽

Cited By ~ 3

Author(s):

Jeonggeun Moon ◽

Minsu Kim ◽

Pyung Chun Oh ◽

Dong Hoon Shin ◽

Hyeon-MI Park ◽

...

Keyword(s):

Transesophageal Echocardiography ◽

Patent Foramen Ovale ◽

Cryptogenic Stroke ◽

Foramen Ovale ◽

Device Closure ◽

Residual Shunt

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Cervical carotid artery may be the most dependable alternative place for detection of patent foramen ovale with contrast transcranial doppler in the patients with insufficient temporal sonic bone window

Journal of the Neurological Sciences ◽

10.1016/j.jns.2009.05.008 ◽

2009 ◽

Vol 284 (1-2) ◽

pp. 225-226 ◽

Cited By ~ 1

Author(s):

Mehmet A. Topcuoglu

Keyword(s):

Carotid Artery ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Foramen Ovale ◽

Bone Window

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Is Migraine Associated with Right-to-Left Shunt a Separate Disease? Results of the SAM Study

Cephalalgia ◽

10.1111/j.1468-2982.2008.01539.x ◽

2008 ◽

Vol 28 (4) ◽

pp. 360-366 ◽

Cited By ~ 24

Author(s):

GP Anzola ◽

G Meneghetti ◽

C Zanferrari ◽

A Adami ◽

L Dinia ◽

...

Keyword(s):

Family History ◽

Observational Study ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

Genetic Linkage ◽

Personal History ◽

Coagulation Disorders ◽

Foramen Ovale ◽

History Of ◽

Pfo Closure

Migraine with aura (MA) is associated with the persistence of patent foramen ovale (PFO) in about 50% of cases, and migraineurs tend to have larger shunts than controls, suggesting that right-to-left shunt (RILES) determined by PFO could play a role in triggering migraine attacks. Moreover, some preliminary reports have suggested that PFO closure may give relief to both migraine and aura attacks. The aim of this study was to clarify if shunt-associated migraine (SAM) has clinical features that allow a distinction from shunt-unrelated migraine (SUM), in a prospective, multicentre, observational study (SAM study). We enrolled consecutive MA patients, who underwent a structured, standardized questionnaire for family and personal history and for detailed migraine features. All were systematically screened for RILES with transcranial Doppler, and for coagulation disorders. Overall, 460 patients were included; the SUM and SAM classes comprised 58% and 42% of patients, respectively. SAM patients were significantly younger (34.1 ± 10 vs. 37.1 ± 11 years), had a more frequent family history of migraine (76% vs. 66%) and a higher frequency of sensory symptoms of aura (51% vs. 41%); by contrast, there was a lesser association of SAM with other cardiac abnormalities and with coagulation disorders. The SAM study suggests that the effect of RILES on migraine features is not relevant. The higher family history of migraine in SAM suggests a possible genetic linkage between migraine and RILES.

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2008000600001 ◽

2008 ◽

Vol 66 (4) ◽

pp. 785-789 ◽

Cited By ~ 10

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.

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Abstract 204: Transcranial Doppler Versus Transthoracic Echocardiography for the Detection of Patent Foramen Ovale in Patients With Cryptogenic Cerebral Ischemia: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Stroke ◽

10.1161/str.47.suppl_1.204 ◽

2016 ◽

Vol 47 (suppl_1) ◽

Author(s):

Georgios Tsivgoulis ◽

Aristeidis H Katsanos ◽

Theodora Psaltopoulou ◽

Theodoros Sergentanis ◽

Alexandra Frogoudaki ◽

...

Keyword(s):

Cerebral Ischemia ◽

Sensitivity And Specificity ◽

Transcranial Doppler ◽

Transthoracic Echocardiography ◽

Patent Foramen Ovale ◽

Diagnostic Yield ◽

Positive Likelihood Ratio ◽

Receiver Operating Curve ◽

Test Accuracy ◽

Foramen Ovale

Background & Purpose: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic cerebral ischemia has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods: We performed a systematic literature review according to PRISMA guidelines to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Results: Our literature search identified 35 eligible studies including 3067 patients. The summary sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (95%CI: 96.5-99.9%). The summary diagnostic odds ratio (DOR) for TCD (DOR=297.97, 95%CI: 131.18-676.83) and TTE (DOR=193.44, 95%CI: 30.38-1231.67) did not significantly differ (z-value=0.418, p=0.676). TTE was superior in terms of higher positive likelihood ratio values (LR+= 106.61, 95%CI: 15.09-753.30 for TTE vs. LR+=12.62, 95%CI: 6.52-24.43 for TCD; p=0.043), while TCD yielded lower negative positive likelihood values (LR- = 0.04, 95%CI: 0.02-0.08) compared to TTE (LR- =0.55, 95%CI: 0.42-0.72; p<0.001). Finally, the area under the summary receiver operating curve was significantly greater (p<0.001) in TCD (AUC=0.98, 95%CI: 0.97-0.99; Figure A) compared to TTE studies (AUC=0.86, 95%CI: 0.82-0.89; Figure B). Conclusions: TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

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