Different Valsalva Manoeuvre Procedures for the Diagnosis of Right-to-Left Shunt by Contrast-Transcranial Doppler

Liu, Chao; Teng, Li; Zhai, Nina; Bu, Ning; Wang, Huqing; Chen, Mengyi; Wu, Haiqin

doi:10.1016/j.ultrasmedbio.2017.04.006

Cited by 3 publications

(2 citation statements)

References 29 publications

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“…Transcranial Doppler examination demonstrated RLS after a “Valsalva maneuver,” strongly suggesting a cardioembolic stroke. 9 , 10 Therefore, anticoagulant therapy for secondary prevention was deemed appropriate. 11 The patient provided informed consent for off-label use of dabigatran and concomitant consideration of PFO closure.…”

Section: Discussionmentioning

confidence: 99%

Young stroke patient with patent foramen ovale and intracranial stenosis—a case report

Šunde,

Ljevak,

Ozretić

et al. 2023

SAGE Open Medical Case Reports

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The prevalence of patent foramen ovale is approximately 20% in the global population. In patients under the age of 55 years, it has been proven as a cause of acute ischemic embolic stroke of otherwise undetermined source. We present a case of a 25-year-old patient who experienced an acute stroke of dominant hemisphere due to internal carotid artery occlusion.The patient underwent mechanical thrombectomy, followed by acute intracranial stenting due to persistent subocclusion of internal carotid artery. Further diagnostic investigations revealed a significant patent foramen ovale. During subsequent follow-up periods, the patient encountered multiple transient ischemic attacks despite receiving antithrombotic therapy. The indicated angiography examination revealed in-stent stenosis and thrombosis, which were resolved after optimal medical treatment. Following patent foramen ovale closure, the patient remained free from further neurological events during the subsequent two-year follow-up periods. This case emphasizes the necessity of comprehensive diagnostic evaluations in young individuals with stroke and underscores the importance of prudent slection of medical therapies.

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Section: Discussionmentioning

confidence: 99%

Young stroke patient with patent foramen ovale and intracranial stenosis—a case report

Šunde,

Ljevak,

Ozretić

et al. 2023

SAGE Open Medical Case Reports

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“…In addition, although some countries have issued corresponding guidelines or consensus ( 22 , 23 ), there are still disputes over some details. For example, the choice of Valsalva implementation time during cTCD, although most recommended after contrast agent (CA) injection, some studies recommended before or during CA injection and different implementation times, will lead to completely different examination results ( 24 , 25 ). Another example, most previous studies diagnosed PFO by echocardiography only using left heart contrast and cardiac cycles after right atrium (RA) opacification, but the definition for quantity of left heart contrast and cardiac cycles varies among studies ( 20 ).…”

Section: The Diagnosis Of Pfomentioning

confidence: 99%

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Shi

Sha²,

Li³

et al. 2023

Front. Neurol.

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Patent foramen ovale (PFO) is a common congenital cardiac abnormality when the opening of the interatrial septum is not closed in adulthood. This abnormality affects 25% of the general population. With the development of precision medicine, an increasing number of clinical studies have reported that PFO is closely related to various neurological diseases such as stroke, migraine, obstructive sleep apnea, and decompression syndrome. It has also been suggested that PFO closure could be effective for preventing and treating these neurological diseases. Therefore, increasing attention has been given to the prevention, diagnosis, and treatment of PFO-related neurological diseases. By reviewing existing literature, this article focuses on the pathogenesis, epidemiology, and clinical characteristics of PFO-related neurological diseases, as well as the prevention and treatment of different neurological diseases to discuss, and aims to provide current progress for this field and decision-making evidence for clinical practice.

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Diagnostic criteria for determining the type of the right-to-left shunt using contrast-enhanced transcranial Doppler ultrasound in young patients with ischemic stroke/transient ischemic attack

Karshieva

Чечеткин

Белопасова

et al. 2023

РНЖ

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Objective. To determine specific diagnostic criteria for detecting the type of the right-to-left shunt by contrast-enhanced transcranial Doppler ultrasound (cTCD) in young patients with paradoxical embolism and ischemic stroke/TIA.Material and methods. The study included 64 ischemic stroke or transient ischemic attack patients (age 28–44 years) with patent foramen ovale (PFO), atrial septal defect (ASD) or pulmonary arteriovenous malformation (PAVM). cTCD was used to assess the degree of shunting, its change during the Valsalva maneuver (VM), time to the fi rst microembolic signal (MES) detection, and the duration of MES registration.Results. According to cTCD data, 20% of patients with PFO had no shunt at rest, and 80% had a mild to moderate right-to-left shunt. After VM, a severe shunt was detected in 75% of patients in this group and a moderate shunt in 25%. All patients with ASD and PAVM had a marked shunt at rest. The difference in time to first MES detection from the start of contrast administration was not statistically significant for all groups. The duration of MES registration that indicated shunting was shorter in patients with PFO compared to those with ASD (p < 0.001) or with PAVM (p < 0.001) and it was significantly longer in patients with PAVM compared to those with ASD (p < 0.001).Conclusion. The key diagnostic criteria to defi ne the right-to-left shunt type are the functional shunt degree at rest and the duration of MES registration. Severe shunting at rest can suggest the presence of ASD or PAVM, while the duration of MES registration > 2 min suggests a PAVM.

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Different Valsalva Manoeuvre Procedures for the Diagnosis of Right-to-Left Shunt by Contrast-Transcranial Doppler

Cited by 3 publications

References 29 publications

Young stroke patient with patent foramen ovale and intracranial stenosis—a case report

Young stroke patient with patent foramen ovale and intracranial stenosis—a case report

Recent progress in patent foramen ovale and related neurological diseases: A narrative review

Diagnostic criteria for determining the type of the right-to-left shunt using contrast-enhanced transcranial Doppler ultrasound in young patients with ischemic stroke/transient ischemic attack

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