Complementarity of contrast transcranial Doppler and contrast transesophageal echocardiography for the detection of patent foramen ovale in stroke patients
Details
Serval ID
serval:BIB_764CD5F60B26
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Complementarity of contrast transcranial Doppler and contrast transesophageal echocardiography for the detection of patent foramen ovale in stroke patients
Journal
European Neurology
ISSN
0014-3022 (Print)
Publication state
Published
Issued date
1997
Volume
38
Number
1
Pages
21-5
Notes
Clinical Trial
Journal Article
Journal Article
Abstract
All studies concerning the detection of patent foramen ovale (PFO) have compared transthoracic or transesophageal echocardiography (c-TEE) to transcranial Doppler ultrasound after contrast injection (c-TCD), but combining both techniques in the search of PFO has received no consideration. Our study aims to substantiate this claim in 37 patients with cryptogenic stroke. It includes two protocols for the detection of PFO to assess the complementarity of c-TCD and c-TEE performed simultaneously or separately. Firstly, we used a standardized protocol, performing c-TCD alone. Secondly, we used a standardized and a simultaneous protocol which associated c-TCD with c-TEE. When c-TCD and/or c-TEE found right-to-left shunts, they were classified as minimal, intermediate and massive. c-TCD revealed all PFO detected by c-TEE in 24 patients out of 37 (65%). Furthermore, c-TCD was positive for a PFO in 5 other patients whereas c-TEE was negative. The degree of right-to-left interatrial shunting varied according to the protocol: c-TCD performed alone found 15 massive, 4 intermediate and 5 minimal shunts whereas 10, 9 and 5, respectively, were detected by c-TCD when it was combined with c-TEE. In contrast, c-TEE revealed 8 massive, 8 intermediate and 8 minimal shunts. c-TCD can identify minimal shunts missed by c-TEE and could be more relevant to detect massive shunts, particularly when not performed simultaneously with c-TEE because no sedation is required for c-TCD alone as opposed to c-TEE: thus patients are more cooperative and produce a better Valsalva strain. c-TEE confirms pulmonary shunts suspected by c-TCD and determines the morphologic characteristics of the interatrial septum. While previous studies opposed c-TEE against c-TCD for the detection of a PFO, we think that both techniques are complementary and that it is interesting to associate them, particularly when they are deferred, to increase the ability of detecting PFO and to specify the degree of right-to-left shunting.
Keywords
Adult
Cerebrovascular Disorders/etiology/therapy/*ultrasonography
Clinical Protocols
Contrast Media
*Echocardiography, Transesophageal/methods
Embolism, Paradoxical/etiology/prevention & control
Female
Heart Septal Defects,
Atrial/complications/physiopathology/therapy/*ultrasonography
Humans
Lung Diseases/complications/physiopathology/ultrasonography
Male
Middle Aged
Prospective Studies
Pulmonary Circulation/physiology
Pulmonary Veins/ultrasonography
Single-Blind Method
*Ultrasonography, Doppler, Transcranial/methods
Pubmed
Web of science
Create date
28/01/2008 11:00
Last modification date
20/08/2019 15:33