Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging

Ha, Jong Won; Shin, Mi Seung; Kang, Seok Min; Pyun, Wook Bum; Jang, Kil Jin; Byun, Ki Hyun; Rim, Se Joong; Huh, Jihoe; Lee, Ki Young; Chung, Namsik

doi:10.1016/s0002-9149(00)01455-7

Cited by 85 publications

(59 citation statements)

References 16 publications

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“…16 Use of harmonic imaging with TT echocardiography and contrast injection may also increase the sensitivity of PFO detection. 17,18 Saline contrast injection can be performed while imaging the heart with a TE probe. Again, PFO is judged to be present with the visualization of microbubbles in the left atrium within 3 cardiac cycles from the right atrial opacification.…”

Section: Contrast Echocardiographymentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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Section: Contrast Echocardiographymentioning

confidence: 99%

Patent Foramen Ovale and Stroke

2005

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“…Transthoracic echocardiography (TTE) allows the population screening by the detection of a shunt with either color Doppler or agitated saline contrast with Valsalva maneuver [Gill and Quaife, 2005;Gramiak et al 1969;Woods and Patel, 2006;Ha et al 2001].…”

Section: Introductionmentioning

confidence: 99%

The new patent foramen ovale occluder FIGULLA in complex septal anatomy: a case series

Baglini¹,

Baldari²,

Amaducci³

et al. 2012

Therapeutic Advances in Cardiovascular Disease

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Background: The appropriate treatment strategy for secondary stroke prevention in patients with cryptogenic stroke and patent foramen ovale (PFO) remains challenging. The aim of this study was to describe a case series of patients with PFO and complex septal anatomy who underwent percutaneous correction using a FIGULLA (Occlutech®) septal occluder (FSO). Patients: Ten consecutive patients (6 females, 4 males, mean age 41.6 ± 16.0 years, range 17-52 years; Group 1) with cryptogenetic stroke and/or transient cerebral ischemia and complex septal anatomy, as defined by intraprocedural transesophageal echocardiogram (TEE) were compared with a group of 25 patients (10 females, 15 males, mean age 43.7 ± 12.3 years; Group 2) with usual tunnel-like PFO anatomy in whom PFO was closed by an Amplatzer septal occluder (ASO; AGA®). Results: No significant differences were noted between Group 1 and Group 2 for immediate success rate, residual intraprosthetic shunt at the end of the procedure, discharge, 1, 6 and 12 months follow up, number of attempts, procedure time, fluoroscopy time, or cardiac complication (atrial arrhythmias, device embolism). The only significant difference was shown for delivery sheath size (11 ± 2 versus 9 ± 1 F) and incidence of local hematoma (30% versus 12 %) between Group 1 and Group 2, without any clinical consequence (need of transfusion) or increase in length of stay. Conclusion: FSO shows high performance in patients with PFO and complex septal anatomy when compared with patients with PFO and uncomplicated atrial anatomy treated by ASO. Its favorable behavior is probably related to fabric features such as the total amount of metal and the presence of titanium.

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“…Perceiving a small degree of right-to-left flow is highly dependent on the sensitivity of the diagnostic technique and additional provocative maneuvers. 36 The finding of an exclusive, unidirectional, left-to-right shunt, particularly at the atrial level, should be interpreted with caution. 37 Finally, this study may have implications for patients with patent foramen ovale, present in Ͼ25% of adults.…”

Section: Khairy Et Al Transvenous Leads and Intracardiac Shunts 2395mentioning

confidence: 99%

Transvenous Pacing Leads and Systemic Thromboemboli in Patients With Intracardiac Shunts

Khairy

Landzberg²,

Gatzoulis³

et al. 2006

Circulation

273

113

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Background— The risk of systemic thromboemboli associated with transvenous leads in the presence of an intracardiac shunt is currently unknown. Methods and Results— To define this risk, we conducted a multicenter, retrospective cohort study of 202 patients with intracardiac shunts: Sixty-four had transvenous leads (group 1), 56 had epicardial leads (group 2), and 82 had right-to-left shunts but no pacemaker or implantable cardioverter defibrillator leads (group 3). Patient-years were accrued until the occurrence of systemic thromboemboli or study termination. Censoring occurred in the event of complete shunt closure, death, or loss to follow-up. Mean ages for groups 1, 2, and 3 were 33.9±18.0, 22.2±12.6, and 22.9±15.0 years, respectively. Respective oxygen saturations were 91.2±9.1%, 88.1±8.1%, and 79.7±6.7%. During respective median follow-ups of 7.3, 9.3, and 17.0 years, 24 patients had at least 1 systemic thromboembolus: 10 (15.6%), 5 (8.9%), and 9 (11.0%) in groups 1, 2, and 3, respectively. Univariate risk factors were older age (hazard ratio [HR], 1.05; P =0.0001), ongoing phlebotomy (HR, 3.1; P =0.0415), and an transvenous lead (HR, 2.4; P =0.0421). In multivariate, stepwise regression analyses, transvenous leads remained an independent predictor of systemic thromboemboli (HR, 2.6; P =0.0265). In patients with transvenous leads, independent risk factors were older age (HR, 1.05; P =0.0080), atrial fibrillation or flutter (HR, 6.7; P =0.0214), and ongoing phlebotomy (HR, 14.4; P =0.0349). Having had aspirin or warfarin prescribed was not protective. Epicardial leads were, however, associated with higher atrial ( P =0.0407) and ventricular ( P =0.0270) thresholds and shorter generator longevity (HR, 1.9; P =0.0176). Conclusions— Transvenous leads incur a >2-fold increased risk of systemic thromboemboli in patients with intracardiac shunts.

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Enhanced detection of right-to-left shunt through patent foramen ovale by transthoracic contrast echocardiography using harmonic imaging

Cited by 85 publications

References 16 publications

Patent Foramen Ovale and Stroke

Patent Foramen Ovale and Stroke

The new patent foramen ovale occluder FIGULLA in complex septal anatomy: a case series

Transvenous Pacing Leads and Systemic Thromboemboli in Patients With Intracardiac Shunts

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