Response to Letter by Mazzucco et al
We thank Mazzucco and coworkers for their new letter, and we read with interest the recent article quoted in it.1
We do agree with the authors that contrast enhanced transcranial Doppler is the most sensible tool to detect right-to-left shunt which is sustained by patent foramen ovale in the great majority of cases. As stated in the previous letter, a complete diagnosis of right-to-left shunt should include transesophageal echocardiography on clinical grounds, but might not be necessary and ethically correct in a research study.
Mazzucco S, Anzola GP, Ferrarini M, Taioli F, Olivato S, Burlina AP, Fabrizi GM, Rizzuto N. Cerebral autosomal dominant arteriopathy with subcortical infarcts and leucoencephalopathy and right-to-left shunt: lack of evidence for an association in a prevalence study. Eur Neurol. 2009; 61: 46–49.