Comparison of transesophageal and transthoracic contrast echocardiography for detection of a patent foramen ovale

Siostrzonek, Peter; Zangeneh, M.; Gössinger, Heinz; Lang, Wilfried; Rosenmayr, Georg; Heinz, Gottfried; Stümpflen, Andreas; Zeiler, K; Schwarz, Martin; Mösslacher, H

doi:10.1016/0002-9149(91)90206-z

Cited by 85 publications

(45 citation statements)

References 8 publications

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“…Echocardiographic identification of right-toleft shunting is often required to diagnose paradoxical embolism. TEE, although the most sensitive technique for shunt detection, 14 did not detect a right-to-left shunt in 12% of patients with an infarct believed to be secondary to PFO. The absence of detectable right-to- left shunting can be explained by insufficient effort on the Valsalva maneuver, insensitivity of TEE to small amounts of shunting, or an infarct mechanism other than paradoxical embolism.…”

Section: Discussionmentioning

confidence: 87%

Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Hanna

Sun

Furlan

et al. 1994

Stroke

124

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Background and Purpose Paradoxical embolism through a patent foramen ovale is a recognized cause of stroke, but clinical predictors, recurrence rate, and prevention of brain infarcts in patients with patent foramen ovale have not been determined. We reviewed transesophageal echocardiographic records to ascertain echocardiographic predictors and optimal prophylaxis for patent foramen ovale-related infarcts.Methods A patent foramen ovale was identified in 74 patients during 615 transesophageal echocardiograms by color Doppler or saline contrast during a 60-month period. On the basis of final clinical situation, the patients were divided into the following groups: group 1, infarct with patent foramen ovale a likely cause (n=16); group 2, infarct with patent foramen ovale an unlikely cause (n=23); and group 3, no infarct (n=35). Transesophageal echocardiograms were reviewed to assess patent foramen ovale characteristics and associated cardioembolic sources without knowledge of clinical details or group assignment. Follow-up after a patent foramen ovale-related infarct was obtained by telephone or written correspondence in 15 of 16 group 1 patients.Results Atrial septal aneurysms were more common in group 1 (38%) compared with group 2 (10%) and group 3

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Section: Discussionmentioning

confidence: 87%

Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Hanna

Sun

Furlan

et al. 1994

Stroke

124

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“…22 TEE is acknowledged as the gold standard in the diagnosis of PFO. 23,24 Spontaneous flow through PFO could be demonstrated by Doppler examination or in some cases, contrast-enhanced echocardiography with agitated saline is used during Valsalva maneuver, enabling the right to left flow can be noted. Shunt is graded according to the bubble count passing from the right to the left atrium.…”

Section: Discussionmentioning

confidence: 99%

Assessment of Morphology of Patent Foramen Ovale with Transesophageal Echocardiography in Symptomatic and Asymptomatic Patients

Bayar

Arslan

Çağırcı

et al. 2015

Journal of Stroke and Cerebrovascular Diseases

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“…Transoesophageal contrast echocardiography is historically regarded as the gold standard for the detection of a patent foramen ovale [9][10][11]. However, recent advances in echocardiographic technology coupled with the femoral access route and provocation with the Valsalva manoeuvre may increase the diagnostic yield of transthoracic echocardiography.…”

Section: Discussionmentioning

confidence: 99%

Paradoxical embolism through a patent foramen ovale: an unexpected complication of tracheal extubation

Turley¹,

Thambyrajah²,

Clarke³

et al. 2005

Anaesthesia

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A 41-year-old male with insulin-dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder. At the end of the surgical procedure, he appeared to regain consciousness but then became unresponsive at the time of tracheal extubation after a violent bout of coughing, developing bilateral up-going plantar responses, decorticate posturing and abnormal pupillary reflexes. He was transferred to the intensive care unit. The following day, the patient made a full neurological recovery. Contrast echocardiography, performed using agitated saline delivered through a femoral venous line, revealed a large patent foramen ovale with evidence of right to left shunting. In the absence of risk factors for air embolism, the clinical diagnosis was one of paradoxical embolism of venous thrombus resulting in brain stem ischaemia. The patient was commenced on life-long aspirin to minimise future embolic risk. A patent foramen ovale is necessary in the fetal circulation to sustain intrauterine life. In utero, placental oxygenated blood enters the right atrium via the inferior vena cava and is directed towards the flap valve of the foramen ovale by the eustachian valve, thus enabling blood to enter the systemic circulation. At birth, the decrease in right-sided cardiac pressures and pulmonary vascular resistance reverses the right to left atrial pressure gradient and causes the flap of the foramen ovale to close against the atrial septum. Fusion is normally complete by the age of 2 years. In cases of incomplete fusion, the foramen ovale is kept sealed by the left atrial to right atrial pressure gradient but may be pushed open if right atrial pressure increases and exceeds that of the left atrium [1,2]. A patent foramen ovale is thus a potential route for emboli arising from the venous system to enter the systemic arterial circulation, resulting in the syndrome of 'paradoxical embolism'. We describe the case of a patient who experienced a paradoxical embolism induced by coughing during tracheal extubation. Case ReportA 41-year-old male with known microvascular complications secondary to insulin-dependent diabetes mellitus was admitted for an elective arthroscopic release of adhesive capsulitis of his left shoulder that had failed to respond to extensive physiotherapy. His past medical history included treated hypertension, micro-albuminuria, bilateral proliferative diabetic retinopathy and left exudative maculopathy with previous extensive panretinal photocoagulation. He had dyslipidaemia, drank alcohol occasionally and was a life-long non-smoker. Overall glycaemic control was good, but he had had several hospital admissions with symptomatic hypoglycaemia. Current medication included insulin, ramipril and over-the-counter analgesics.Six months previously, he had successfully undergone an elective arthroscopic release of his right shoulder with an excellent functional result. On this occasion, the general anaesthetic technique included fentanyl, propofol, atracurium and morphine...

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Comparison of transesophageal and transthoracic contrast echocardiography for detection of a patent foramen ovale

Cited by 85 publications

References 8 publications

Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Patent foramen ovale and brain infarct. Echocardiographic predictors, recurrence, and prevention.

Assessment of Morphology of Patent Foramen Ovale with Transesophageal Echocardiography in Symptomatic and Asymptomatic Patients

Paradoxical embolism through a patent foramen ovale: an unexpected complication of tracheal extubation

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