Standardized method for the detection of patent foramen ovale using transcranial colour-coded sonography, and comparison of the results with transesophageal echocardography [Pesquisa protocolada de Foramen Oval Patente com Doppler Transcraniano codificado a cor e sua comparação com o Ecocardiograma Transesofágico]

• Type: Article in International Scientific Journal
• Date: 2005

Authors

Joana Guimaraes (Author) FMUP; Santos, R (Author) Other; Sousa, G (Author) Other; de Oliveira, P (Author) Other; Azebedo, E (Author) Other

Journal

Title: Sinapse

Vol. 5

Pages: 21-24

ISSN: 1645-281X

Publisher: Sociedade Portuguesa de Neurologia

Indexing

Scopus - 0 Citations

Other information

Authenticus ID: P-007-DDB

Abstract (EN): Introduction: Patent foramen ovale (PFO) has been identified as a potential risk factor for stroke in young adults. Contrast-enhanced transcranial Doppler sonography (TCD) for the detection of cardiac right-to-left shunts (RLS) seems to be a high diagnostic acuity technique. Nevertheless, one should follow a standardized methodology for a more generalized acceptance of the method, and for its reproducibility. Purpose: Following recommendations from Consensus Conference of the European Society of Neurosonology and Cerebral Hemodynamics (ESNCH), in 1999, to compare TCD and transesophageal echocardiography (TEE) in PFO detection. Methods: Consecutive young adults patients admitted in our department with cryptogenic stroke or transient ischemic attack were included. Patients were examined with contrast transcranial colour-coded sonography (c-TCCS) and TEE. C-TCCS was performed insonating middle cerebral artery while injecting an agitated saline contrast solution (9cc SF + 1cc air) in the cubital vein. Five seconds after this injection the patient starts a 10s calibrated Valsalva manoeuvre, with strength controlled by a manometer. Four level categorization was considered according to the number of microembolic signals (MES) appearance in the TCD spectrum: (1) 0 MES (negative result); (2) 1-10 MES; (3) >10MES and no curtain; (4) curtain (a single MES cannot be identified). Results: Thirteen patients were evaluated using this methodology (8 man and 5 woman; mean age 36 years); 8 patients (62%) presented a positive test (4 with 1-10MB; 1>10MB with no curtain and 3 with curtain). In 7 of the 8 patients TEE confirmed PFO; the case not detected by TEE had only 2 MES in c-TCCS. Discussion: With the presented methodology, contrast TCD has been shown in the literature to detect TEE-proven RLS with a sensitivity of over 93-96% and a specificity of 59-73%. Our small series agrees with this high diagnostic acuity. Moreover, VM can be more comfortably applied during TCD than TEE, and therefore functional relevance of RLS can be more easily assessed with this method, which might influence therapeutic decision.

Language: Portuguese

Type (Professor's evaluation): Scientific