Diagnostic Accuracy of Transesophageal Echocardiogram for the Detection of Patent Foramen Ovale: A Meta‐Analysis

Mojadidi, Mohammad K.; Bogush, B S Nikolay; Caceres, Jose Diego; Msaouel, Pavlos; Tobis, Jonathan M.

doi:10.1111/echo.12462

Cited by 116 publications

(74 citation statements)

References 49 publications

(69 reference statements)

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“…In most cases, transesophageal echocardiography is required for the diagnosis [4,5]. It is well known that patent foramen ovale is a risk factor for cerebral infarction; the resulting conditions are referred to as cryptogenic strokes or strokes of unclear origin.…”

Section: Discussionmentioning

confidence: 99%

A case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis

Hashimoto¹,

Sasaki²,

Mizunuma³

et al. 2017

Ren Replace Ther

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Background: The authors herein report a case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis. The clinical manifestations of paradoxical cerebral infarction are nonspecific, and the diagnosis is sometimes difficult to establish. Patients with paradoxical cerebral infarction may present with neurologic abnormalities or features suggesting arterial embolism. And paradoxical cerebral infarction has been associated with foramen ovale (PFO). Case presentation: A multi-lumen catheter for dialysis was inserted into the right internal jugular vein. After injecting heparin-added physiological saline solution to confirm the patency of the catheter, paradoxical cerebral infarction developed. Detailed examination revealed PFO. PFO patent is a common condition that affects one in four people. Conclusion: The size of multi-lumen catheter for dialysis is relatively large. We learned from this case that the use of multi-lumen catheter poses a potential risk of paradoxical infarction. Clinicians should be aware that central venous catheter is a risk factor for paradoxical cerebral infarction.

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Section: Discussionmentioning

confidence: 99%

A case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis

Hashimoto¹,

Sasaki²,

Mizunuma³

et al. 2017

Ren Replace Ther

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“…Although TEE bubble study is currently considered as the gold standard for PFO investigation, false-negative results or misdiagnosed RLS may occur. 55,56 Moreover, it is technically challenging to perform adequate Valsalva maneuver during TEE investigation. 55,56 TCD is a more sensitive (sensitivity: 95%-98%) method for the diagnosis of RLS compared with TEE (sensitivity: 80%-100%) 57-59 but does not provide any information about other potential cardiac and aortic embolic sources.…”

Section: Discussionmentioning

confidence: 99%

Recurrent Stroke and Patent Foramen Ovale

Katsanos

Spence

Bogiatzi

et al. 2014

Stroke

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T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 15% to 35%. 1 In patients with cryptogenic stroke, PFO is more common, but a clear causative relationship is not well established.2 Recurrent cerebrovascular events are frequent in medically treated patients with a history of paradoxical embolism 3 ; however, in more than one third of these patients concurrent pathogeneses (other than the sole presence of PFO) are identified. 4,5 Thus, it still remains unclear whether PFO is causally related to firstever or recurrent cerebral ischemia or constitutes an incidental finding of diagnostic work-up. 6,7 PFO size and the degree of functional shunting could represent potential risk factors for cerebral ischemia in medically treated patients with PFO.8 PFOs in patients with cerebral ischemia are thought to be larger 9 and to be more frequently associated with atrial septal aneurysms, compared with the PFOs in asymptomatic patients. 10 Moreover, in transcranial Doppler (TCD) studies, large PFOs were found to be significantly associated with more microembolic signals compared with small PFOs.11,12 However, data from other studies suggest that the shunt grade assessed with TCD is not associated with the brain infarct volume on computed tomography 13

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“…TCD has been demonstrated to have high sensitivity and specificity for detection of rightto-left shunting when compared to contrast transesophageal echocardiography and is superior to transthoracic echocardiography. [15][16][17][18][19][20][21][22] Transthoracic echocardiography (TTE) with agitated saline has decreased sensitivity of detecting an intracardiac shunt in OSA patients with elevated BMI and large body habitus secondary to limited acoustic windows. 13,21 Using passage of a guide wire across the atrial septum during cardiac catheterization with intracardiac echocardiography guidance as the standard for diagnosing a PFO, TCD has a 98% sensitivity for making the diagnosis of PFO.…”

Section: Methodsmentioning

confidence: 99%

“…[15][16][17][18][19][20] Compared with heart catheterization for PFO detection, TCD is more sensitive than TEE since there is a 10% false negative rate with TEE because patients cannot perform a Valsalva maneuver with a TEE probe down their esophagus. 20,[22][23][24] The patients in our study with OSA and PFO did not undergo PFO closure, which would be needed to evaluate a cause and effect relationship.…”

Section: Limitationsmentioning

confidence: 99%

Sleep Apnea in Patients with and without a Right-to-Left Shunt

Mojadidi

Bokhoor

Gevorgyan

et al. 2015

Journal of Clinical Sleep Medicine

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BRIEF SUMMARYCurrent Knowledge/Study Rationale: Right-to-left shunt (RLS) occurs more frequently in patients with sleep apnea, and may be involved in the pathophysiology of sleep apnea. In this observational study, we determined the prevalence of RLS among patients with sleep apnea and compared clinical characteristics and the results of sleep studies of patients with and without RLS. Study Impact: Patients with OSA and RLS have hypoxemia out of proportion to the observed respiratory disturbance, highlighting the likely role of RLS in the resultant nocturnal desaturation. Such observational studies support the hypothesis that the presence of a RLS from a PFO may exacerbate sleep apnea symptoms Objectives: To assess the presence of right-to-left shunting (RLS) in patients with obstructive sleep apnea (OSA), and compare clinical characteristics and parameters of the sleep studies of patients with and without RLS. Background: The most common cause of RLS is due to intermittent fl ow through a patent foramen ovale (PFO). PFO occurs more frequently in patients with OSA and may be involved in the exacerbation of OSA. Methods: Patients with an abnormal polysomnogram seen at UCLA-Santa Monica Sleep Medicine Clinic were enrolled. A diagnosis of RLS was made using a transcranial Doppler (TCD) bubble study. Gender and age-matched controls were drawn from patients referred for cardiac catheterization who underwent a TCD. The frequency of RLS in OSA patients and the controls was evaluated. Clinical characteristics and polysomnogram parameters were compared between OSA patients with and without a RLS. Results: A total of 100 OSA patients and 200 controls participated in the study. The prevalence of RLS was higher in patients with OSA compared to the control group (42% versus 19%; p < 0.0001). Patients with OSA and a RLS had a lower apnea-hypopnea index (AHI), less obstructive apnea, and fewer hypopnea episodes than patients with OSA without a RLS. The baseline and nadir SpO 2 were similar in both groups and did not correlate with the level of RLS assessed by TCD. The degree of desaturation for a given respiratory disturbance, as measured by oxygen desaturation index (ODI)/AHI ratio, was higher in OSA patients with RLS versus OSA patients without RLS (0.85 ± 0.07 versus 0.68 ± 0.04; p < 0.0001). Conclusion: RLS, most commonly due to a PFO, occurs 2.2 times more frequently in OSA patients compared to a control population that was matched for age and gender. The severity of sleep apnea is not greater in OSA patients who have a PFO. However, patients with OSA and a PFO are more likely to become symptomatic at a younger age with an equivalent decrease in nocturnal SpO 2 , and have greater arterial desaturation in proportion to the frequency of respiratory disturbances. Keywords: sleep apnea, patent foramen ovale, right-to-left shunt Citation: Mojadidi MK, Bokhoor PI, Gevorgyan R, Noureddin N, MacLellan WC, Wen E, Aysola R, Tobis JM. Sleep apnea in patients with and without a right-to-left shunt. J Clin Sleep Med 2015;11(11):1299 -...

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Diagnostic Accuracy of Transesophageal Echocardiogram for the Detection of Patent Foramen Ovale: A Meta‐Analysis

Cited by 116 publications

References 49 publications

A case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis

A case of paradoxical cerebral infarction by spraying thrombus in the catheter for dialysis

Recurrent Stroke and Patent Foramen Ovale

Sleep Apnea in Patients with and without a Right-to-Left Shunt

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