Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography

Porter, Thomas R.; Abdelmoneim, Sahar S.; Belcik, J. Todd; McCulloch, Marti; Mulvagh, Sharon L.; Olson, Joan; Porcelli, C; Tsutsui, Jeane Mike; Wei, Kevin

doi:10.1016/j.echo.2014.05.011

Cited by 222 publications

(159 citation statements)

References 38 publications

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“…The purpose of these maneuvers is to transiently increase right-sided filling pressures, which can improve the ability to detect intracardiac shunting. 34 Although early studies demonstrated a sensitivity of close to 50%, 35,36 more contemporary studies have indicated that it has increased to 80-90%, an improvement that is likely related to technical improvements in imaging quality. 37, 38 Given the reduced sensitivity, it is not surprising, therefore, that the estimated prevalence…”

Section: Detectionmentioning

confidence: 99%

Patent Foramen Ovale and Stroke

Sun

Homma

2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp coalesce into a single orifice that becomes the foramen secundum. The septum secundum then forms via involution of the ventrocranial wall and overlaps with the foramen secundum. The septum secundum does not close fully and an oval-shaped opening remains, which becomes the foramen ovale. 17 Prior to birth, the fetus is dependent on the maternal circulation for oxygenation, as the immature fetal lungs do not yet participate in oxygen exchange. As such, the foramen ovale (as well as the ductus arteriosus), enables shunting of blood away from the pulmonary circulation. At birth, when the neonate's lungs begin to participate in oxygen exchange, there is a precipitous drop in the pulmonary vascular resistance and there is reversal of flow through both the foramen ovale and ductus arteriosus. 18 In approximately 75% of individuals, the foramen ovale closes within a few years while in the remaining others, it stays open permanently as a PFO. EpidemiologyThe prevalence of PFO in the healthy adult population ranges from 15% to 25% on echocardiography and 15-35% on autopsy studies. 1,2,19,20 Observational and autopsy studies have showed that the prevalence of detected PFOs is lower in older patients and that detected PFOs in older individuals tend to be larger. 1,19,20 Those studies, however, may be confounded by selection and detection bias because none of the longitudinal studies have demonstrated that individual PFOs change in size. The prevalence of PFOs is equal among men and women, though there may be race-ethnic differences. 1,19,21 he foramen ovale is an important fetal structure that closes after birth in most individuals and remains open as a patent foramen ovale (PFO) in approximately 25% of the healthy population. 1-3 In these individuals, bypass of the pulmonary circulation via shunting from the right-sided venous circulation to the left-sided arterial circulation is possible. Although most patients with PFOs are completely asymptomatic, reports from the late 1800 s by Cohnheim and Litten described cases of patients who were found to have the triad of deep venous thrombosis (DVT), PFO and systemic embolization. They hypothesized that the PFO enabled bypass of a venous thrombosis to the systemic arterial circulation, a process now termed paradoxical embolization. 4,5 Since those initial observations, additional studies have demonstrated a strong association between the presence of PFO and cryptogenic stroke in young patients. 6-11 In addition to its association with stroke, PFO has also been implicated in platypneaorthodeoxia, 12 decompression illness, 13 myocardial infarction, 14 obstructive sleep apnea, 15 and migraine headaches. 16 This review will focus on the relationship between PFO and stroke, discussing the embryology, epidemiology, association, mechanisms, diagnostic methods, associated anatomic factors and management strategies. EmbryologyThe right and left atria begin as a single chamber and separation b...

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Section: Detectionmentioning

confidence: 99%

Patent Foramen Ovale and Stroke

Sun

Homma

2016

Circ J

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“…Multicenter studies have shown that ultrasound contrast agents have an excellent safety profile with incidence of serious adverse events ranging from 0.0086% to 0.031% (24)(25)(26)(27). Furthermore, these contrast agents do not pose nephrotoxicity risks as they are fully excreted via the respiratory tract (28)(29)(30).…”

Section: Discussionmentioning

confidence: 99%

Contrast enhanced ultrasound guided biopsies of liver lesions not visualized on standard B-mode ultrasound—preliminary experience

Partovi

Kessner

et al. 2017

J. Gastrointest. Oncol.

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“…Strong consideration should be given to the use of a microbubble contrast agent when indicated to enhance endocardial definition and improve the precision of LVEF measurement. 20 LV Internal Dimension at End-Diastole. In addition to the LVEF, the LV internal dimension at end-diastole (LVIDd) from 2D parasternal long-axis images is a critical measurement in LVAD candidates.…”

Section: Dysfunctionmentioning

confidence: 99%