Contrast-Enhanced Transcranial Doppler Ultrasound for Diagnosis of Patent Foramen Ovale

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

Arquivos de Neuro-Psiquiatria ◽

10.1590/s0004-282x2012000800004 ◽

2012 ◽

Vol 70 (8) ◽

pp. 578-582 ◽

Cited By ~ 2

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.

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A Study on the Relationship Between Patent Foramen Ovale and White Matter Lesions in Migraine Patients

10.21203/rs.3.rs-251075/v1 ◽

2021 ◽

Author(s):

Junyan Huo ◽

Mengxia Wan ◽

Nan Li ◽

Juan Wang ◽

Xiao Cai ◽

...

Keyword(s):

White Matter ◽

Transcranial Doppler ◽

Patent Foramen Ovale ◽

White Matter Lesions ◽

Primary Headache ◽

Transcranial Doppler Ultrasound ◽

Foramen Ovale ◽

Significant Difference ◽

The Difference ◽

The Relationship

Abstract Background Migraine is a common clinical primary headache with unclear aetiology. In recent years, studies have shown that migraine is related to patent foramen ovale, and some patients with migraine have white matter lesions. However, the relationship among the three is unclear.Objective To explore the characteristics of white matter lesions (WMLs) in migraine patients with patent foramen ovale and to predict the occurrence of patent foramen ovale through magnetic resonance imaging (MRI) characteristics in patients with migraine.Methods Seventy-seven patients clinically diagnosed with migraine were examined by transcranial Doppler ultrasound (cTCD) and MRI. The patients were grouped according to the presence of WMLs, with matching by age, sex, hypertension, diabetes, PFO and other characteristic data. We observed the MRI fluid attenuation inversion recovery sequence (FLAIR) image and compared and analysed the difference in WMLs between the PFO-positive group and the PFO-negative group.Results There were 42 cases and 35 cases of migraine with and without WMLs, respectively. A statistically significant difference in near-cortical WMLs with PFO in migraine patients was observed (P=0.001). Logistic regression analysis adjusted by age, sex, hypertension and diabetes identified PFO status as the sole determinant for the presence of near-cortical WMLs (OR = 0.14; 95%CI 0.045–0.421; p < 0.001)Conclusion Near-cortical white matter lesions in migraine patients are related to PFO. Transcranial Doppler ultrasonography may reveal more PFO in patients with migraine and near-cortical WMLs.

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

Polish Hyperbaric Research ◽

10.2478/phr-2019-0008 ◽

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.

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