Cardiac Magnetic Resonance Imaging and Transesophageal Echocardiography in Patients With Transcatheter Closure of Patent Foramen Ovale

Nusser, Thorsten; Höher, Martin; Merkle, Nico; Grebe, Olaf; Spiess, Jochen; Kestler, Hans A.; Rasche, Volker; Kochs, Matthias; Hombach, Vinzenz; Wöhrle, Jochen

doi:10.1016/j.jacc.2006.03.036

Cited by 63 publications

(29 citation statements)

References 15 publications

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“…In CaMRISS, 4 of these patients had a LGE of ≥3 dysfunctional wall segments (Table 4), indicating an independent risk factor for thrombus formation as shown in a previous study. 13 In accordance with previous publications, including either 25 21 or 75 patients with cryptogenic stroke, 22 respectively, contrast-enhanced cvMRI failed to properly assess left atrial shunts in CaMRISS patients. Despite of the fact that a patent foramen ovale-even in combination with an atrial septum aneurysm-or an atrial septum defect is considered to be a low or uncertain risk source of embolism, 24 this is a limitation of cvMRI in practice.…”

Section: Discussionsupporting

confidence: 82%

“…16,17 Moreover, cardiac MRI is superior to echocardiography on detection of recent or previous myocardial infarction. 18,19 Although a few MRI studies reported the prevalence of specific (potential) embolic sources after stroke, 15,[20][21][22] these studies did not provide a comprehensive statement on the diagnostic value of cardiovascular MRI (cvMRI) compared with the current gold standard of TEE and TTE assessment of acute ischemic stroke etiology.…”

Section: May 2017mentioning

confidence: 99%

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Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

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E tiologic work-up is essential in patients with acute ischemic stroke to optimize secondary stroke prevention. According to international guidelines, state-of-the-art diagnostic work-up includes brain imaging, ultrasound of brainsupplying arteries, echocardiography, ECG monitoring, and distinct blood tests.1,2 However, stroke etiology remains undetermined (cryptogenic) in about 25% of all acute ischemic stroke patients. 3 Apart from nonpermanent atrial fibrillation (AF), 4 ventricular noncompaction, left atrial or ventricular thrombi, mitral or aortic valve stenosis, and ulcerated aortic arch atherosclerotic plaques are associated with a moderate to high embolic stroke risk and were found in a substantial part Background and Purpose-Etiology of acute ischemic stroke remains undetermined (cryptogenic) in about 25% of patients after state-of-the-art diagnostic work-up. Methods-One-hundred and three patients with magnetic resonance imaging (MRI)-proven acute ischemic stroke of undetermined origin were prospectively enrolled and underwent 3-T cardiac MRI and magnetic resonance angiography of the aortic arch in addition to state-of-the-art diagnostic work-up, including transesophageal echocardiography (TEE). We analyzed the feasibility, diagnostic accuracy, and added value of cardiovascular MRI (cvMRI) compared with TEE for detecting sources of stroke. Despite interstudy variations on the definition and prevalence of (potential) embolic sources, current guidelines recommend diagnostic echocardiography in stroke patients. 2Although noninvasive transthoracic echocardiography (TTE) is easy to use, semi-invasive transesophageal echocardiography (TEE) is typically needed to visualize the left atrium, left atrial appendage, atrial shunts, and the aortic arch-all of them potential sources of embolism.6 Serious complications during TEE rarely occur.7 However, required preprocedural fasting, periprocedural conscious sedation, and the demand of highly skilled personnel limit its availability and cause in-hospital delays. 8 In consequence, TEE is not routinely performed in (cryptogenic) stroke patients, even in high-income countries.9 Subsequently, assessment of potential embolic sources of ischemic stroke is often inappropriate in clinical practice. Although cardiac computed tomography could add information about stroke etiology, 10 the main disadvantage of this approach is the exposure to radiation. Cardiac magnetic resonance imaging (MRI) has been increasingly often implemented in the clinical diagnostic workflow of various cardiac diseases over the past 10 years and allows for accurate biventricular functional analysis and tissue characterization. Cardiac MRI is now considered the gold standard to assess cardiac tumors, myocarditis, cardiomyopathies, and subclinical coronary heart disease. 11,12 In addition, cardiac MRI has demonstrated feasibility of detecting atrial or ventricular thrombi, 13 aortic atherosclerotic plaques, 14,15 or left atrial enlargement. 16,17 Moreover, cardiac MRI is superior to echocardiography on d...

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Section: Discussionsupporting

confidence: 82%

Section: May 2017mentioning

confidence: 99%

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Hæusler

Wollboldt

Bentheim

et al. 2017

Stroke

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“…5,10 -14 Although we have shown that present CMRI technique is inferior to TEE in detection of contrast-enhanced right-to-left shunting and identification of atrial septal aneurysm, 5 we could also demonstrate that routine CMRI after transcatheter closure of PFO is feasible and safe. 5,15,16 Velocity mapping CMRI is a well-validated approach to directly quantify the severity of regurgitant semilunar valves. [17][18][19][20][21][22] In combination with ventricular volumetric data, insufficiencies of the atrioventricular valves can be quantified with excellent reproducibility.…”

Section: Editorial See P 2967 Clinical Perspective On P 3008mentioning

confidence: 85%

“…Indication for PFO closure was based on cryptogenic ischemic events as defined elsewhere 5 and evidence of a PFO with contrast-enhanced interatrial right-to-left-shunt at rest or during Valsalva provocation as seen in transesophageal echocardiography. Diagnostic work-up before PFO closure included 12-lead ECG, Holter monitoring, Doppler sonography, transthoracic echocardiography, TEE, and coagulation blood tests.…”

Section: Patientsmentioning

confidence: 99%

“…[1][2][3][4] Efficacy has been addressed by evidence of PFO closure determined in transthoracic echocardiography, transesophageal echocardiography (TEE), [3][4][5] and cardiac magnetic resonance imaging (CMRI). 5,6 During long-term follow-up, recurrence of ischemic events such as stroke, transient ischemic event, or peripheral emboli has been analyzed. 2,3,7 With respect to safety complications during device implantation, 2 atrial erosion 8 and thrombus formation on the device 4 were the focus.…”

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confidence: 99%

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Impact of Percutaneous Device Implantation for Closure of Patent Foramen Ovale on Valve Insufficiencies

et al. 2009

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Background-In patients with percutaneous device implantation for closure of patent foramen ovale (PFO), a 10% incidence of new or worsened aortic regurgitation within 12 months has been reported with echocardiography. Cardiac magnetic resonance imaging is a powerful noninvasive tool to quantify volume and fraction of valve insufficiencies. We studied the acute and long-term impact of percutaneous device implantation for PFO closure on valve insufficiencies in cardiac magnetic resonance imaging. Methods and Results-Sequential cardiac magnetic resonance imaging studies were performed in 102 patients with cryptogenic ischemic events. Cardiac magnetic resonance imaging was performed before PFO closure, the day after device implantation, and at 12 months of follow-up. There was no difference in volumetric and hemodynamic parameters before PFO closure compared with 12 months of follow-up. With a cutoff for relevant regurgitation fraction of 5%, there were no statistically significant differences in regurgitation fraction of the semilunar and atrioventricular valves. The median fraction of aortic valve insufficiency was 3.9% (interquartile range [IQR] 2.0% to 5.1%) before PFO closure, 5.4% (IQR 4.1% to 5.9%) after device implantation, and 4.3% (IQR 3.3% to 6.0%) at 12 months of follow-up. The size and type of the occluder had no impact on aortic valve insufficiency. Median regurgitation fraction for the pulmonary valve was 3.6% (IQR 2.4% to 6.7%) before intervention, 7.3% (IQR 5.1% to 8.2%) after occluder implantation and 5.8% (IQR 4.8% to 7.4%) at 12 months of follow-up. Values for the mitral valve were 3.1% (IQR 1.4% to 6.0%), 5.5% (IQR 3.5% to 7.3%), and 3.8% (IQR 1.5% to 7.9%) and for the tricuspid valve were 5.4% (IQR 0.1% to 8.8%), 5.8% (IQR 1.4% to 9.2%), and 6.0% (IQR 1.1% to 8.4%), respectively. Conclusions-Percutaneous

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Cardioembolic stroke

Mikati

Ibrahim

2019

Warlow's Stroke

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Cardiac Magnetic Resonance Imaging and Transesophageal Echocardiography in Patients With Transcatheter Closure of Patent Foramen Ovale

Abstract: The present CMRI technique is inferior to TEE in detection of contrast-enhanced right-to-left shunting and identification of ASA.

Cited by 63 publications

References 15 publications

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Feasibility and Diagnostic Value of Cardiovascular Magnetic Resonance Imaging After Acute Ischemic Stroke of Undetermined Origin

Impact of Percutaneous Device Implantation for Closure of Patent Foramen Ovale on Valve Insufficiencies

Cardioembolic stroke

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