(Stroke. 1996;27:2251-2255.)
© 1996 American Heart Association, Inc.
Articles |
Patent Foramen Ovale and Transcranial Doppler
Comparison of Different Procedures
the Departments of Neurological Sciences (E.M.Z., G.M., M.S.) and Clinical Medicine (S. De C., D.C.), University "La Sapienza," and the Department of Organ and System Pathophysiology, Istituto Superiore di Sanita (F.C.), Rome, Italy.
Correspondence to Prof Elietta M. Zanette, Department of Neurological Sciences, University "La Sapienza," Viale dell'Universita, 30, 00185 Rome, Italy.
Background and Purpose The capability of transcranial Doppler sonography (TCD) to detect a patent foramen ovale (PFO) has been established. However, which provocative maneuver and what timing of contrast injection are most effective to induce a right-to-left shunt has not yet been determined.
Methods We selected 38 cerebrovascular patients (21 men, 17 women) with positive contrast study for PFO on transesophageal echocardiography. Patients underwent a TCD with bilateral monitoring of the middle cerebral arteries (MCAs) and injection of a contrast solution. The injection was repeated (1) during normal breathing (basal conditions); (2) before Valsalva maneuver (VM); (3) during VM; (4) immediately after VM; and (5) during cough. The latency time and the total number of microbubbles for each side were recorded.
Results TCD found positive results for PFO in 30 patients. Twenty were positive even during basal conditions. The number of positive cases varied according to the timing of the VM in relation to the contrast injection: 28, 25, and 27 cases were positive when the injection was performed before, during, and after VM, respectively, while 26 were positive during cough. There were significant differences in the number of microbubbles in the MCAs between the procedures (P<.001, ANOVA): the highest number was detected in the injection before VM and the lowest number during basal conditions (P<.001, Wilcoxon's test with Bonferroni's correction). The latency time was significantly shorter when the injection followed VM.
Conclusions The injection performed before VM appeared to be the most effective TCD procedure in determining the transit of microbubbles through a PFO and subsequently in the MCAs.
Key Words: echocardiography, transesophageal • foramen ovale, patent • transcranial Doppler • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  M. Del Sette, L. Dinia, D. Rizzi, A. Sugo, B. Albano, and C. Gandolfo Diagnosis of Right-to-Left Shunt With Transcranial Doppler and Vertebrobasilar Recording Stroke, August 1, 2007; 38(8): 2254 - 2256. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Kassab, A. Majid, M. U. Farooq, H. Azhary, L. A. Hershey, E. M. Bednarczyk, D. F. Graybeal, and M. D. Johnson Transcranial Doppler: An Introduction for Primary Care Physicians J Am Board Fam Med, January 1, 2007; 20(1): 65 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Engelhardt, W. Folkers, C. Brenke, M. Scholz, A. Harders, H. Fidorra, and K. Schmieder Neurosurgical operations with the patient in sitting position: analysis of risk factors using transcranial Doppler sonography Br. J. Anaesth., April 1, 2006; 96(4): 467 - 472. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. W. Schuchlenz, G.P. Anzola, E. Morandi, F. Casilli, and E. Onorato Contrast Ultrasound Techniques in the Detection and Quantification of Patent Foramen Ovale: Myth Versus Reality * Response: Stroke, December 1, 2004; 35(12): 2755 - 2756. [Full Text] [PDF]
|
|
|
|
 |
|
 N. Uzuner, S. Horner, G. Pichler, D. Svetina, and K. Niederkorn Right-to-Left Shunt Assessed by Contrast Transcranial Doppler Sonography: New Insights J. Ultrasound Med., November 1, 2004; 23(11): 1475 - 1482. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Devuyst, B. Piechowski-Jozwiak, T. Karapanayiotides, J.-W. Fitting, V. Kemeny, L. Hirt, L. A. Urbano, P. Arnold, G. van Melle, P.-A. Despland, et al. Controlled Contrast Transcranial Doppler and Arterial Blood Gas Analysis to Quantify Shunt Through Patent Foramen Ovale Stroke, April 1, 2004; 35(4): 859 - 863. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J Landzberg and P. Khairy Indications for the closure of patent foramen ovale Heart, February 1, 2004; 90(2): 219 - 224. [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, S. Lakemeier, T. Wichter, J. Stypmann, R. Dittrich, M. Ritter, M. Moeller, M. Freund, and E. B. Ringelstein Optimizing the Technique of Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts Stroke, September 1, 2002; 33(9): 2211 - 2216. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. Arquizan, J. Coste, P.-J. Touboul, and J.-L. Mas Is Patent Foramen Ovale a Family Trait? : A Transcranial Doppler Sonographic Study Stroke, July 1, 2001; 32(7): 1563 - 1566. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. De Castro, D. Cartoni, M. Fiorelli, M. Rasura, A. Anzini, E. M. Zanette, M. Beccia, C. Colonnese, F. Fedele, C. Fieschi, et al. Morphological and Functional Characteristics of Patent Foramen Ovale and Their Embolic Implications Stroke, October 1, 2000; 31(10): 2407 - 2413. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, K. Silling, J. Stypmann, M. Grude, V. Kemeny, T. Wichter, K. Kuhne, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Time Window and Threshold in Microbubble Numbers Stroke, July 1, 2000; 31(7): 1640 - 1645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, J.-U. Kriete, J. Stypmann, M. Castrucci, T. Wichter, R. Tietje, B. Weltermann, P. Young, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Comparison of Different Procedures and Different Contrast Agents Stroke, September 1, 1999; 30(9): 1827 - 1832. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F J Kirkham Stroke in childhood Arch. Dis. Child., July 1, 1999; 81(1): 85 - 89. [Full Text]
|
|
|
|
|
|
J. J. Schwarze, D. Sander, C. Kukla, I. Wittich, V. L. Babikian, and J. Klingelhofer Methodological Parameters Influence the Detection of Right-to-Left Shunts by Contrast Transcranial Doppler Ultrasonography Stroke, June 1, 1999; 30(6): 1234 - 1239. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. W. Droste, M. Reisener, V. Kemeny, R. Dittrich, G. Schulte-Altedorneburg, J. Stypmann, T. Wichter, and E. B. Ringelstein Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts : Reproducibility, Comparison of 2 Agents, and Distribution of Microemboli Stroke, May 1, 1999; 30(5): 1014 - 1018. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. Ay, F. S. Buonanno, S. A. Abraham, J. P. Kistler, and W. J. Koroshetz An Electrocardiographic Criterion for Diagnosis of Patent Foramen Ovale Associated With Ischemic Stroke Stroke, July 1, 1998; 29(7): 1393 - 1397. [Abstract] [Full Text] [PDF]
|
|