Patent Foramen Ovale and Transcranial Doppler

Zanette, E.; Mancini, G.B. John; Castro, S. De; Solaro, M.; Cartoni, Domenico; Chiarotti, Flavia

doi:10.1161/01.str.27.12.2251

Cited by 75 publications

(74 citation statements)

References 23 publications

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“…20,25 In most studies, VM was performed after injection. Zanette et al 15 were the first to systematically investigate the most appropriate timing for the performance of the VM. They also found the highest sensitivity when the VM was performed after injection compared with its performance before or during the injection.…”

Section: Discussionmentioning

confidence: 99%

“…The injection of the contrast agent was performed before, 4,[11][12][13][14][15][16][17][18] during, 15,17,19 or after the VM. 15,20 In those studies in which the VM was performed after injection, the time delay between injection and VM was frequently not clearly specified in relation to the start or the end of injection. In the studies with a clear specification, the time from the beginning of injection to the beginning of the VM ranged between 0 and 5 seconds.…”

mentioning

confidence: 99%

“…In the studies with a clear specification, the time from the beginning of injection to the beginning of the VM ranged between 0 and 5 seconds. 4,11,12,15 (2) Several authors use a threshold for the number of MES detected in the TCD recording; most authors, however, qualify the test as positive when at least 1 MES can be identified. Thresholds proposed for the number of MES are Ն4, 21 Ն6, 18 and Ն11.…”

mentioning

confidence: 99%

“…22 Furthermore, the question of whether the use of a diagnostic time window for MES appearance increases the specificity of the test without necessarily decreasing sensitivity is not yet resolved. 14,23,24 Time windows proposed between the intravenous injection of the contrast medium and its appearance in the MCAs are 6 heartbeats, 20 10 seconds, 20,21 15 seconds, 13 20 seconds, 24 22 seconds, 15 and 25 seconds. 11,14 A recent study described the necessity of including MES at least 20 to 25 seconds after the start of injection to achieve a high sensitivity; it may also be possible that no time window is necessary.…”

mentioning

confidence: 99%

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Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

109

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Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Valsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of 10 mL of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity and specificity of combined results of the tests with VM. Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least 1 TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the results of 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions-TCD performed twice with 2 provocation maneuvers with Echovist is a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Droste

Silling

Stypmann

et al. 2000

Stroke

109

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“…Previous studies with different CAs demonstrated that CA infusion during the VM and before the VM showed good sensitivity values compared to contrast-enhanced transesophageal echocardiography (cTEE) for RLS diagnosis, preferentially for PFO diagnosis [1][2][3][4]10 . An international consensus suggested that the VM should start five seconds after the beginning of the CA injection and should be maintained for at least five seconds 1 .…”

Section: Resultsmentioning

confidence: 99%

Valsalva maneuver procedures in the diagnosis of right-to-left shunt by contrast-enhanced transcranial doppler using agitated saline solution with blood as a contrast agent

Lange

Zétola

Piovesan

et al. 2010

Arq. Neuro-Psiquiatr.

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Objective: To compare two different timings for the performance of the Valsalva maneuver (VM) using an infusion of agitated saline solution with blood as contrast agent (CA) to right-to-left shunt (RLS) screening. Method: 42 patients were submitted to a standardized contrast-enhanced transcranial doppler (cTCD) to screen for right-to-left shunt (RLS Contrast-enhanced transcranial doppler (cTCD) is a reliable and reproducible screening method for right-to-left shunt (RLS) diagnosis 1,2 . The Valsalva maneuver (VM) increases the positive results of standardized cTCD studies by 45% by increas-

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Transcatheter closure of patent foramen ovale in older adults

Kiblawi

Sommer

Levchuck

2006

Cathet Cardio Intervent

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Patent Foramen Ovale and Transcranial Doppler

Abstract: The injection performed before VM appeared to be the most effective TCD procedure in determining the transit of microbubbles through a PFO and subsequently in the MCAs.

Cited by 75 publications

References 23 publications

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Contrast Transcranial Doppler Ultrasound in the Detection of Right-to-Left Shunts

Valsalva maneuver procedures in the diagnosis of right-to-left shunt by contrast-enhanced transcranial doppler using agitated saline solution with blood as a contrast agent

Transcatheter closure of patent foramen ovale in older adults

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