Transcranial Doppler and Transesophageal Echocardiography: Comparison of Both Techniques and Prospective Clinical Relevance of Transcranial Doppler in Patent Foramen Ovale Detection

Caputi, Luigi; Carriero, Maria Rita; Falcone, Chiara; Parati, Eugenio; Piotti, Patrizia; Materazzo, Carlo; Anzola, Gian Paolo

doi:10.1016/j.jstrokecerebrovasdis.2008.12.001

Cited by 82 publications

(83 citation statements)

References 41 publications

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“…25 However, the optimal management of PFO is still debatable. 12,13 Thus, quantifying the amount of shunt may not impact on current clinical practice. Our study has a number of limitations.…”

Section: Discussionmentioning

confidence: 99%

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Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Agustin

Yumul

Kalaw

et al. 2011

Stroke

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Background and Purpose-There is controversy about the optimal patient position for the detection of right-to-left shunt (RLS). The study was performed to investigate which patient position best detects RLS during contrast-enhanced transcranial Doppler. Methods-We prospectively evaluated consecutive patients with ischemic stroke or TIA referred to our Noninvasive Cerebrovascular Laboratory for suspected paradoxical embolism. The standard protocol for RLS detection recommended by the International Consensus Criteria was followed. Each patient was examined at rest and after Valsalva maneuver in 4 positions: supine, right lateral decubitus, right lateral leaning, and upright sitting, in random order. RLS was graded 0 (no microbubbles [mB] detected), 1 (1-10 mB), 2 (Ͼ10 mB but no curtain), and 3 (curtain, shower of mB). Blood pressure, heart rate, and neurological symptoms were monitored. Data were analyzed using SPSS version 17. Results-RLS

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Section: Discussionmentioning

confidence: 99%

“…Contrast-enhanced transcranial Doppler (cTCD) has been found to be comparable or complementary to transesophageal echocardiogram in detecting clinically significant RLS. [12][13][14] It is rapid, safe, well-tolerated, and can be performed at the patient's bedside.…”

mentioning

confidence: 99%

Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Agustin

Yumul

Kalaw

et al. 2011

Stroke

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“…60 Thus, the combination of TEE with TCD could be considered as the ideal method for the investigation of paradoxical embolism in patients with cryptogenic stroke. 61 The variation of demographic characteristics among individual studies and within the subgroups of the same study (Table 1) should be taken into account when interpreting our findings. Moreover, baseline medications including antiplatelets (range, 75%-100%) or anticoagulants (range, 0%-25%) were found to vary widely not only among studies but also probably within subgroups (Table in the onlineonly Data Supplement).…”

Section: Discussionmentioning

confidence: 99%

Recurrent Stroke and Patent Foramen Ovale

Katsanos

Spence

Bogiatzi

et al. 2014

Stroke

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T he frequency of patent foramen ovale (PFO) in the general population has been estimated to be 15% to 35%. 1 In patients with cryptogenic stroke, PFO is more common, but a clear causative relationship is not well established.2 Recurrent cerebrovascular events are frequent in medically treated patients with a history of paradoxical embolism 3 ; however, in more than one third of these patients concurrent pathogeneses (other than the sole presence of PFO) are identified. 4,5 Thus, it still remains unclear whether PFO is causally related to firstever or recurrent cerebral ischemia or constitutes an incidental finding of diagnostic work-up. 6,7 PFO size and the degree of functional shunting could represent potential risk factors for cerebral ischemia in medically treated patients with PFO.8 PFOs in patients with cerebral ischemia are thought to be larger 9 and to be more frequently associated with atrial septal aneurysms, compared with the PFOs in asymptomatic patients. 10 Moreover, in transcranial Doppler (TCD) studies, large PFOs were found to be significantly associated with more microembolic signals compared with small PFOs.11,12 However, data from other studies suggest that the shunt grade assessed with TCD is not associated with the brain infarct volume on computed tomography 13

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“…Furthermore, the not rare patency of the foramen ovale increases the risks of paradoxical arterial air embolism, which can lead to myocardial and hemodynamic dysfunction, arrhythmia, and secondary brain damage [15][16][17][18]. Transesophageal echocardiography (TEE), analysis of carbon dioxide arterial partial pressure (PaCO 2 ), and capnography (endtidal CO 2 , ETCO 2 ) are the standard systems to directly or indirectly detect air embolism during neurosurgical procedures in the sitting position.…”

Section: Introductionmentioning

confidence: 99%

Carbon dioxide field flooding reduces the hemodynamic effects of venous air embolism occurring in the sitting position

et al. 2015

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Transcranial Doppler and Transesophageal Echocardiography: Comparison of Both Techniques and Prospective Clinical Relevance of Transcranial Doppler in Patent Foramen Ovale Detection

Cited by 82 publications

References 41 publications

Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler

Recurrent Stroke and Patent Foramen Ovale

Carbon dioxide field flooding reduces the hemodynamic effects of venous air embolism occurring in the sitting position

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