Echocardiographic Detection and Transcranial Doppler Quantification of Right-to-Left Shunting

Onorato, Eustaquio; Casilli, Francesco; Anzola, Gian Paolo

doi:10.1007/978-1-4471-4987-3_5

Cited by 3 publications

(3 citation statements)

References 52 publications

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“…A diagnosis of PFO is valid if any micro-bubbles are visualised in the left atrium within three cardiac cycles from maximal right atrial opacification (6). The PFO can also be visualised on TOE, as a flap opening in the muscular wall of the septum secundum (7). The study is usually conducted with a provocation manoeuvre such as the Valsalva manoeuvre, in order to raise intra-thoracic pressures to subsequently increase the right-to-left shunt.…”

Section: Diagnosismentioning

confidence: 99%

“…TTE can also be used to diagnose a PFO, however with less sensitivity in comparison to TOE (6,12,13). The use of harmonic imaging and colour Doppler with TTE may increase the sensitivity of detection from 46% to 90% (5,7). However, TTE may be preferred in cases where a transoesophageal probe poses high risk, such as in patients with oesophageal varices or strictures.…”

Section: Diagnosismentioning

confidence: 99%

“…The biggest disadvantage of TCD is the lack of visualisation of the shunt, thus lacking the ability to differentiate between PFO and other rightto-left shunts. Given the ease of use, accuracy, and high sensitivity of this imaging modality, there may be a possible role for c-TCD as a screening tool preceding TTE (7).…”

Section: Diagnosismentioning

confidence: 99%

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Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale

Vaidya

Khandkar

Celermajer

2018

Cardiovasc. Diagn. Ther

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A patent foramen ovale (PFO) is a remnant interatrial communication, best diagnosed with transoesophageal echocardiography (TOE) and bubble study. Although quite common and often asymptomatic, PFO is associated with cryptogenic stroke and migraine. Approximately one-half of patients with a cryptogenic stroke have a PFO, and the dilemma regarding whether or not to proceed with percutaneous device closure, to reduce the risk of future recurrent events due to paradoxical embolism, has been subject to debate for nearly two decades. Despite promising observational data, initial randomised clinical trials failed to demonstrate superiority of closure over medical therapy. However, long-term follow-up data from one of these early trials, combined with two new randomised trials, have provided more evidence for the benefits of closure in selected patients. This new evidence suggests that younger patients with high-risk features such as an atrial septal aneurysm (ASA) or large interatrial shunt are more likely to benefit from PFO closure, after fastidious exclusion of an alternative cause for the index stroke. However, issues which require further clarification include whether anticoagulant therapy is preferable to antiplatelet therapy for medical management, and which particular type of closure device is optimal. Finally, despite promising retrospective observational data suggesting improvement in migraine attacks after PFO closure, high quality evidence is lacking in this regard.

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Section: Diagnosismentioning

confidence: 99%

Section: Diagnosismentioning

confidence: 99%

See 1 more Smart Citation

Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale

Vaidya

Khandkar

Celermajer

2018

Cardiovasc. Diagn. Ther

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Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study

et al. 2017

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The Case for Selective Patent Foramen Ovale Closure After Cryptogenic Stroke

Wiktor

Carroll

2018

Circ: Cardiovascular Interventions

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Controversy has persisted for over a decade whether transcatheter patent foramen ovale (PFO) closure reduces the rate of recurrent ischemic stroke for patients who have had a cryptogenic ischemic stroke and have a PFO. In September 2017, 3 positive randomized trials: RESPECT long-term (Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment trial), REDUCE (GORE® HELEX® Septal Occluder / GORE® CARDIOFORM Septal Occluder and Antiplatelet Medical Management for Reduction of Recurrent Stroke or Imaging-Confirmed TIA in Patients With Patent Foramen Ovale [PFO]), and CLOSE (Patent Foramen Ovale Closure or Anticoagulants Versus Antiplatelet Therapy to Prevent Stroke Recurrence) were published. All 3 trials studied young to middle age patients with cryptogenic ischemic strokes found to have a PFO, and compared recurrent stroke rates after PFO closure versus medical therapy alone. All trials had primary end points of recurrent ischemic strokes, a superiority design, and reported results in the intention to treat population. The long-term results of the RESPECT trial led to the Food and Drug Administration approval of the AMPLATZER PFO Occluder for a secondary prevention indication. There was a 45% risk reduction in the device arm for recurrent ischemic stroke with an event rate of 0.58 versus 1.07 per 100 patient-years (hazard ratio, 0.55; 95% confidence interval, 0.305-0.999; log-rank =0.046). The primary efficacy result of the REDUCE trial utilizing the HELEX and CARDIOFORM devices demonstrated a risk reduction of 77% (hazard ratio, 0.23; 95% confidence interval, 0.09-0.62; log-rank=0.001). In the CLOSE trial, device closure plus long-term antiplatelet therapy versus antiplatelet therapy alone demonstrated a risk reduction of 97% (hazard ratio, 0.03; 95% confidence interval, 0-0.25; log-rank <0.001). Each trial demonstrated a low frequency of device- and procedure-related complications, including a slight increase in the rate of paroxysmal atrial fibrillation in the device arm. This review focuses on summarizing the trial results and translating the results and methods from investigative trials into clinical practice.

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Echocardiographic Detection and Transcranial Doppler Quantification of Right-to-Left Shunting

Cited by 3 publications

References 52 publications

Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale

Current management aspects in adult congenital heart disease: non-surgical closure of patent foramen ovale

Can neuroimaging differentiate PFO and AF-related cardioembolic stroke from the other embolic sources? Clinical-radiological correlation on a retrospective study

The Case for Selective Patent Foramen Ovale Closure After Cryptogenic Stroke

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