Transcranial doppler ultrasonography should it be the first choice for persistent foramen ovale screening?

Monika Komar, Maria Olszowska, Tadeusz Przewłocki, Jakub Podolec, Jakub Stępniewski, Bartosz Sobień, Rafał Badacz, Anna Kabłak-Ziembicka, Lidia Tomkiewicz-Pająk, Piotr Podolec
2014 Cardiovascular Ultrasound  
Persistent foramen ovale (PFO) is considered a cause of cryptogenic stroke and a risk factor for neurological events in young patients. The reference standard for identifying a PFO is contrast-enhanced transesophageal echocardiography (TEE). The goal of this study was to evaluate the feasibility of transcranial color Doppler (TCD) and its diagnostic sensitivity compared with TEE. Methods: We investigated 420 patients admitted to our department with cryptogenic stroke, transient ischemic attacks
more » ... or other neurological symptoms. All patients underwent TCD and TEE evaluation. TCD and TEE examinations were performed according to a standardized procedure: air-mixed saline was injected into the right antecubital vein three times, while the Doppler signal was recorded during the Valsalva maneuver. During TCD the passage of contrast into the right-middle cerebral artery was recorded 25 seconds following the Valsalva maneuver. Results: We detected a right-to-left shunt in 220 patients (52.3%) and no-shunts in 159 patients (37.9%) with both TCD and TEE. In 20 (4.8%) patients TEE did not reveal contrast passage which was then detected by TCD. In 21 (5.0%) patients only TEE revealed a PFO. The feasibility of both methods was 100%. TCD had a sensitivity of 95% and a specificity of 92% in the diagnosis of PFO. Conclusions: TCD has a relatively good sensitivity and specificity. TCD and TEE are complementary diagnostic tests for PFO, but TCD should be recommended as the first choice for screening because of its simplicity, non-invasive character, low cost and high feasibility.
doi:10.1186/1476-7120-12-16 pmid:24884981 pmcid:PMC4046065 fatcat:3hw6pjxg4zg73pi2fggn5jy2cq