A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver

Abstract

Patent foramen ovale (PFO) is a remnant of the fetal circulation exist in 20% of the general population. The purpose of our study was to compare of transthoracic echocardiography (TTE) and contrast-transcranial Doppler sonography (c-TCD) in the diagnosis and quantification of PFO with or without the Valsalva maneuver (VM).We studied 106 patients with a high clinical suspicion for PFO prospectively. Simultaneous c-TCD and TTE were conducted using agitated saline solution to detect right to left shunt (RLS). To classify RLS, mainly PFO, we applied a 4-level visual classification for c-TCD test: no occurrence of micro-embolic signals; grade I, 1 to 10 signals; grade II, 10 to 30 signals but not curtain; and grade III, curtain pattern. We used the number of micro-bubbles appeared in left atrium per frame image to define classification for TTE test: no occurrence of micro-bubbles; grade I, 1 to 10 micro-bubbles; grade II, 10 to 30 micro-bubbles; and grade III, more than 30 micro-bubbles or left atrium nearly filled with micro-bubbles or left atrial opacity. Statistical analyses were performed using SPSS Version 18.0.RLS was detected in 36.0% in c-TCD test and in 46% in TTE test at rest (P = 0.158). And during the VM, RLS was detected in 99.0% in c-TCD test and in 83.0% in TTE test (P < 0.001). Compared with the positive results of c-TCD and TTE at rest, the positive results of them with VM is more higher, respectively (all P < 0.001). The VM obviously increased the number of micro-bubbles shunting.Both c-TCD and TTE should used as initial screening tool for PFO. VM increases the size of shunt. VM resulted in detection of more RLS both in c-TCD and TTE tests.

A comparison of contrast transthoracic echocardiography and contrast transcranial Doppler in cryptogenic stroke patients with patent foramen ovale

“…Maffè et al had reported that cTTE and cTCD had comparable sensitivity compared with TEE, with TEE as the reference standard, 89% for TTE, and 85% for TCD (Kühl et al, ; Maffè et al, ; Souteyrand et al, ). These are consistent with the results of our present study (González‐Alujas et al, ; Jong‐Won et al, ; Zhao et al, ).…”

Prevalence and grade of RLS in migraine: a prospective study of 251 migraineurs by synchronous test of c-TTE and c-TCD

“…During VM, contrast agent was injected 5 s before the start of VM. This was produced by the patients blowing into a small soft plastic tube connected to the manometer device, patients then started the VM on the examiner's command and held it for 5 s.We assessed the effective VM by monitoring the peak flow velocity of the MCA Doppler spectrum was decreased by at least 25%, and the manometer device achieved and maintained a pressure of 40 mm Hg [12]. When TTE detected micro-bubbles signals (MES) in the left atrium within 3 ~ 5 cardiac cycles, and TCD detected more than 1 MES appeared within 10 seconds after VM, then we regarded the c-TCD results as positive.…”

The optimal anesthesia mothod for external cephalic version (ECV): a randomized controlled trial

“…The incidence of single breech pregnancy was 3-4% [1][2][3]. Due to increased risk of injury to the neonate during attempted vaginal delivery, 90% of full-term breech-presenting pregnancy women may have to choose cesarean section [4,5]. ECV is encouraged to reposition the fetus to a vertex presentation to avoid cesarean delivery [6], which is also considered as a cost-effective breech treatment with few complications.…”