Right-to-Left Shunt Evaluated at the Aortic Arch by Contrast-Enhanced Transesophageal Echocardiography

Yasaka, Masahiro; Ikeno, Koichi; Otsubo, Ryoichi; Oe, Hiroshi; Nagano, Keiko; Minematsu, Kazuo

doi:10.7863/jum.2005.24.2.155

Cited by 9 publications

(6 citation statements)

References 6 publications

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“…Diagnosis of PCE due to PFO was based on the criteria described by Yasaka et al [14,15] (Table 1) and considered as ''definite'' or ''probable''. For diagnosis of PFO, in cases where an opening could not be clearly identified on transesophageal echocardiography (TEE), presence or absence of PFO was assessed after release of Valsalva strain.…”

Section: Methodsmentioning

confidence: 99%

Factors related to recurrence of paradoxical cerebral embolism due to patent foramen ovale

et al. 2011

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Patent foramen ovale (PFO) is an important etiology of ischemic stroke in young adults. We investigated factors contributing to recurrent ischemic stroke in patients with PFO. Subjects comprised 47 patients (mean age, 56.8 ± 14.2 years; range 23-74 years) with ischemic stroke due to PFO who were admitted to our hospital between April 2007 and February 2011. Mean duration of follow-up was 34.5 ± 13 months. Recurrence occurred in 11 cases. Annual recurrence rate was 23.4%. We investigated relationships between recurrence of ischemic stroke and size of PFO (large, >4 mm; medium, 2-3.9 mm; small, <1.9 mm; absent group), maximal number of microbubbles (determined as the number of microembolic signals: small, 0-5; moderate, 6-25; and multiple, ≥ 26), massive bubble on contrast transesophageal echocardiography or atrial septal aneurysm, D-dimer level and antithrombotic therapy. Univariate analysis showed size of the PFO (P = 0.013), number of microbubbles (P = 0.021), and presence of a massive bubble on echocardiography (P = 0.04) were related to recurrence of ischemic stroke. Logistic analysis identified size of the PFO (P < 0.05) and massive bubble on echocardiography (P < 0.05) as factors related to recurrence of ischemic stroke. In conclusion, size of the PFO and presence of a massive bubble were considered to be factors associated with recurrence of ischemic stroke due to PFO.

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Section: Methodsmentioning

confidence: 99%

Factors related to recurrence of paradoxical cerebral embolism due to patent foramen ovale

et al. 2011

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“…An ulcer was defined as a crater on the plaque ≥2.0 mm in depth and width, as in previous studies (figure 1). 10 15 16 21 In addition, TOE was used to detect possible cardiac embolic sources, including intracardiac thrombus, an SEC in the left atrium or atrial appendage, a mitral strand, an atrial septal aneurysm and a right-to-left shunt documented on a contrast-enhanced technique 22. Each finding on TOE was assessed by trained vascular neurologists and, sometimes, by additional trained cardiologists.…”

Section: Methodsmentioning

confidence: 99%

Ulcerated plaques in the aortic arch contribute to symptomatic multiple brain infarction

Yoshimura

Toyoda

Kuwashiro

et al. 2010

Journal of Neurology, Neurosurgery & Psychiatry

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“…Other possible causes of stroke at the aortic arch were also evaluated, including a large atheromatous plaque (focal increases in IMT ≥4.0 mm) [4,5], an ulcerated plaque (a crater on the plaque ≥2 mm in depth and width) [8,9,14], and a spontaneous echo contrast. In addition, TEE was used to detect emboligenic heart diseases, including intracardiac thrombus, spontaneous echo contrast in the left atrium or appendage, a mitral valve strand, atrial septal aneurysm, and right-to-left shunt documented using a contrast-enhanced technique, including a patent foramen ovale [15]. In addition, 24-hour electrocardiography and transthoracic echocardiography were performed in all patients.…”

Section: Methodsmentioning

confidence: 99%

Atheromatous Plaques at the Origin of the Left Subclavian Artery in Patients with Ischemic Stroke

et al. 2010

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Background: Atheromatous plaques of the aortic arch that extend to the origin of its branches may cause stroke. The frequency and clinical implications of plaque at the origin of the left subclavian artery (LSCA) in patients with recent ischemic stroke were investigated. Methods: We studied 347 consecutive patients (223 men, 69 ± 12 years) who developed symptomatic ischemic stroke and underwent transesophageal echocardiography (TEE). Results: The origin of the LSCA was identified in 303 of 347 patients (87.3%). Plaque ≧1.0 mm was detected in 108 of the 303 patients (35.6%), ranging between 1.0 and 6.1 mm (median, 2.5 mm). Patients having thicker plaque (≧2.5 mm) were older (p = 0.012) and more commonly took antiplatelets prior to stroke (p = 0.038) than patients with no plaque and those with thinner plaque (<2.5 mm). Of the aortic arch findings detected on TEE, maximum intima-media thickness (IMT) was the highest (p < 0.001) in patients with thicker plaque, and large plaque (≧4.0 mm) (p = 0.017), ulcerative plaques (p < 0.001), and spontaneous echo contrasts (p = 0.001) were identified most commonly in patients with thicker plaque. The frequency of infarcts involving the posterior circulation was similar among the three groups. After multivariate adjustment, maximum IMT of the aortic arch was independently related to thicker plaque at the LSCA origin (OR = 1.24, 95% CI = 1.03–1.51, p = 0.024, per 1-mm increase). Conclusions: Atheromatous plaque at the origin of the LSCA was present in approximately one third of patients with a recent ischemic stroke. High IMT at the aortic arch was independently related to the presence of thick plaque at the LSCA origin. The present study does not support the concept that plaque at the LSCA origin may be associated with posterior circulation infarction.

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Right-to-Left Shunt Evaluated at the Aortic Arch by Contrast-Enhanced Transesophageal Echocardiography

Abstract: The cTEE-AA may be an alternative method for detection of an RLS, especially in patients with a large amount of NSSIC in the left atrium.

Cited by 9 publications

References 6 publications

Factors related to recurrence of paradoxical cerebral embolism due to patent foramen ovale

Factors related to recurrence of paradoxical cerebral embolism due to patent foramen ovale

Ulcerated plaques in the aortic arch contribute to symptomatic multiple brain infarction

Atheromatous Plaques at the Origin of the Left Subclavian Artery in Patients with Ischemic Stroke

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