Transcranial Duplex Sonography in the Detection of Patent Foramen Ovale

Blersch, Wendelin; Draganski, Bogdan; Holmer, Stefan; Koch, Horst J.; Schlachetzki, Felix; Bogdahn, U.; Hölscher, Thilo

doi:10.1148/radiol.2253011572

Cited by 68 publications

(43 citation statements)

References 32 publications

(27 reference statements)

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“…High-intensity transient signals (HITS) were counted for 25 s after the end of the Valsalva manoeuvre, and the numbers of HITS were classified in one of four categories (zero HITS, 1−10 HITS, >10 HITS without curtain, and curtain) following the Blersch method [4]. TEE was performed by using an echocardiograph device "Philips Sonos 5500" (Andover, MA, USA) equipped with a multi-frequency probe S3 and transoesophageal multi-polar probe.…”

Section: Methodsmentioning

confidence: 99%

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High prevalence of patent foramen ovale in migraine with aura

Ferrarini¹,

Malferrari

Zucco³

et al. 2005

J Headache Pain

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IntroductionThe patent foramen ovale (PFO) is a residue of foetal circulation and is found to be patent in approximately 20%− 30% of the adult population. In these subjects there is an interatrial right-to-left (R-L) shunting when right atrial pressure exceeds the pressure present in the left atrium. The association between PFO and stroke and other neurological diseases has been well documented by both perspective and historical studies [1,2].Transoesophageal sonography represents the gold standard for the diagnosis and follow-up of patients suffering from neurological diseases possibly due to J Headache Pain (2005) 6:71-76 DOI 10.1007 High prevalence of patent foramen ovale in migraine with aura Abstract In this study we evaluated the presence of patent foramen ovale (PFO) in a cohort of 25 consecutive patients suffering from migraine with aura (MA) during an attack presenting to the emergency ward of an Italian hospital. Patients underwent brain magnetic resonance imaging (MRI) with contrast medium, routine coagulation tests, contrast transcranial echocolour-coded sonography (c-TCCS) and transoesophageal echocardiography (TEE). Of the enrolled patients, 88.7% showed a PFO according to the c-TCCS test, whereas only in 72% TEE confirmed the presence of PFO. This discordance could be due to the fact that c-TCCS is more sensitive even with shunts with minimal capacity also located in the pulmonary vasculature. After surgical treatment of the PFO, MA disappeared within two months. Also, the treatment with warfarin as well as with acetylsalicylic acid and flunarizine was able to dramatically reduce the frequency of migraine attacks. These data indicate a higher prevalence of PFO in MA vs. normal population (OR=2.92) and could suggest that the presence of arteriovenous (AV) shunts could represent a trigger for MA attacks as well as for stroke, but more studies are needed to confirm this preliminary hypothesis.

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Section: Methodsmentioning

confidence: 99%

“…This technique can also detect the morphological features of the shunts, and this is significant because the amplitude of the shunt is related to the embolic entities [3]. Conversely, contract transcranial Doppler (c-TCD) is the most sensitive method to detect R-L shunts, the majority of which are due to PFO [4,5].…”

mentioning

confidence: 99%

High prevalence of patent foramen ovale in migraine with aura

Ferrarini¹,

Malferrari

Zucco³

et al. 2005

J Headache Pain

View full text Add to dashboard Cite

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“…It has the advantage of visualizing the site of the right-to-left shunt together with its mor- phology and hemodynamic significance. TTE has been found to be less sensitive in diagnosing PFO than TEE, although supported by detection of right to left bubble passage after intravenous administration of agitated saline contrast on TMD, its utilization becomes considerable [14,15] TCD, as a noninvasive tool, is a potential alternative to TEE, however it evidences the presence of right-to-left shunt solely without indicating its site [16].…”

Section: Discussionmentioning

confidence: 99%

Patient with patent foramen ovale and thrombophilia, after ischemic stroke, acute coronary syndrome and pulmonary embolism (RCD code: IV-2B.O)

Komar

Stępniewski

Przewłocki

et al. 2015

Journal of Rare Cardiovascular Diseases

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Patent foramen ovale (PFO) is a residue of the foramen ovale, an integral part of the normal fetal circulation. It closes in most of newborns, however 25-30% of adults may have it patent. Conditions such as crytpogenic stroke, migraine and vascular headaches or decompression sickness are strongly related to the presence of PFO. Less frequently acute myocardial infarction, renal infarction or acute mesenteric ischemia may also occur. We present a case of a 67-year-old man after cerebral ischemic episode, acute myocardial infarction treated with primary coronary intervention and pulmonary embolism, who was eventually diagnosed with PFO and factor V Leiden mutation. Life-long anticoagulation was initiated in this patient as a standard-of-care. He additionally underwent successful percutaneous PFO closure. As a result no subsequent thromboembolic complication occurred in this patient at the follow-up period. JRCD 2015; 2 (2): 52-55

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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%

“…TCD is limited by its inability to identify the location of the shunt; however, almost all right-toleft shunts are due to PFOs or small ASDs since other etiologies, such as large trans-pulmonary shunting from pulmonary AVMs, are rare (1% of TCD exams). [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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Transcranial Duplex Sonography in the Detection of Patent Foramen Ovale

Abstract: c-TCCS is a sensitive noninvasive method for detecting cardiac right-to-left shunt and is as sensitive as c-TEE.

Cited by 68 publications

References 32 publications

High prevalence of patent foramen ovale in migraine with aura

High prevalence of patent foramen ovale in migraine with aura

Patient with patent foramen ovale and thrombophilia, after ischemic stroke, acute coronary syndrome and pulmonary embolism (RCD code: IV-2B.O)

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

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