Importance of Adequately Performed Valsalva Maneuver to Detect Patent Foramen Ovale during Transesophageal Echocardiography

2013 ◽  
Vol 26 (11) ◽  
pp. 1337-1343 ◽  
Author(s):  
Ana Clara Rodrigues ◽  
Michael H. Picard ◽  
Aime Carbone ◽  
Ana Lúcia Arruda ◽  
Thaís Flores ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Foramen Ovale

scholarly journals Diagnosis of Patent Foramen Ovale: The Combination of Contrast Transcranial Doppler, Contrast Transthoracic Echocardiography, and Contrast Transesophageal Echocardiography

2020 ◽  
Vol 2020 ◽  
pp. 1-7
Author(s):  
Xiaoxue Yang ◽  
Hua Wang ◽  
Yajuan Wei ◽  
Nina Zhai ◽  
Baomin Liu ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Large Sample Size ◽  
Foramen Ovale ◽  
Practical Strategy ◽  
First Choice ◽  
Nonsignificant Difference

Objectives. To access the distinct values of contrast transcranial Doppler (cTCD), contrast transthoracic echocardiography (cTTE), and contrast transesophageal echocardiography (cTEE) in the diagnosis of right-to-left shunt (RLS) due to patent foramen ovale (PFO) and to define the most practical strategy for the diagnosis of PFO. Methods. 102 patients with a high clinical suspicion for PFO had simultaneous cTCD, cTTE, and cTEE performed. The agitated saline mixed with blood was used to detect right-to-left shunt (RLS). Results. In all 102 patients, the shunt was detected at rest by cTCD in 60.78% of cases, by cTTE in 42.16%, and by cTEE in 47.06%. The positive results of all 3 techniques with Valsalva maneuver (VM) were significantly improved. cTCD showed higher pick-up rate than cTTE (98.04% vs. 89.22%; χ2=12.452, p<0.05) and the cTEE (98.04% vs. 96.08%; nonsignificant difference) in the diagnosis of PFO. Nevertheless, cTEE, compared with cTTE, underestimated shunting in 44% of patients. The diameter of both PFO entrance and exit was significantly greater in patients with a severe shunt compared with a mild shunt (2.8±1.0 mm vs. 2.0±0.7 mm, t=3.135, p<0.05; 2.2±0.7 mm vs. 1.6±0.4 mm, t=−2.582, p<0.05). There was a nonsignificant difference in tunnel length between patients with mild shunting and severe shunting(9.3±2.7 mm vs. 9.4±2.9 mm; t=1.358, p>0.05). Conclusions. The best method to diagnose PFO should be the combination of cTCD, cTTE, and cTEE. And cTCD should be applied as the first choice for screening RLS. Then, cTTE should be performed to quantify the severity of the shunt. Last but not least, cTEE should be performed to assess the morphologies of PFO when the closure is planned. The study provides for clinicians the most practical strategy for diagnosing PFO in the future. However, further trials with a large sample size are required to confirm this finding.

Abstract 3266: Detection Of Patent Foramen Ovale By Transesophageal Echocardiography and Contrast-Enhanced Cardiac Magnetic Resonance In Patients With Cryptogenic Stroke.

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Alfonso Sestito ◽  
Pasquale Santangeli ◽  
Priscilla Lamendola ◽  
Fabio Pilato ◽  
Christian Colizzi ◽  
...  
Keyword(s):  
Ischemic Stroke ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Contrast Echocardiography ◽  
Cryptogenic Stroke ◽  
Foramen Ovale ◽  
Contrast Enhanced

Background. In ≈ 40% of patients with acute ischemic stroke, the cause remains undefined (cryptogenic stroke). Previous studies, using contrast echocardiography, showed a significant prevalence of a patent foramen ovale (PFO) in patients with cryptogenic stroke < 55 years of age, suggesting a causal role through paradoxical embolism. Contrast transesophageal echocardiography (TEE) is considered the gold standard for PFO detection. Recently, however, cardiac magnetic resonance (CMR) was also shown to reliably detect PFO. In this study we compared the accuracy of CMR and TEE in detecting PFO in a group of patients with cryptogenic stroke. Methods and Results . Sixteen patients (age 50 ± 13 years, 9 males) with cryptogenic ischemic stroke underwent contrast-enhanced TEE and contrast CMR for detection of possible PFO. Both imaging studies were performed during Valsalva maneuver. PFO grading results were assessed visually both for TEE and CMR, according to the entity of contrast passage in the left atrium (grade 0 = no PFO; grades 1, 2 and 3 = mild, medium and wide PFO, respectively). Nine patients (56%) were identified to have a PFO by contrast TEE. Contrast-enhanced CMR identified a PFO in only 5 (56%) of these patients. None of the 7 patients without PFO at TEE was shown to have a PFO at CMR. TEE showed a grade 1 PFO in 4 patients, a grade 2 PFO in 3 and a grade 3 PFO in 2 patients. Of these patients, CMR failed to identify PFO in all patients with a grade 1 PFO at TEE and underestimated the degree of the shunt in the other patients. Conclusions. Our data suggest that TEE should be considered the non-invasive diagnostic reference test to detect and characterize PFO in patients with ischemic cryptogenic stroke.

scholarly journals Recurrent Patent Foramen Ovale-Related Cerebral Infarcts Alternately Causing Bilateral Hand Paresis

2017 ◽  
Vol 9 (2) ◽  
pp. 210-215 ◽  
Author(s):  
Seung-Jae Lee
Keyword(s):  
Ischemic Stroke ◽  
Transesophageal Echocardiography ◽  
Patent Foramen Ovale ◽  
Holter Monitoring ◽  
Precentral Gyrus ◽  
Foramen Ovale ◽  
Rare Presentation ◽  
Laboratory Findings ◽  
Abnormal Finding ◽  
Hand Motor Area

Isolated hand paresis is a rare presentation of stroke, which mostly results from a lesion in the cortical hand motor area, a knob-like area within the precentral gyrus. I report the case of a patient who experienced recurrent ischemic stroke alternately involving bilateral hand knob areas, causing isolated hand paresis. There was no abnormal finding on brain and neck magnetic resonance angiography, transthoracic echocardiography, and 48-h Holter monitoring, and there were no abnormal immunologic and coagulation laboratory findings. The only embolic source was found to be a patent foramen ovale, which was proven on transesophageal echocardiography. The patient underwent percutaneous device closure of patent foramen ovale after alternately repeated paresis of both hands despite antiplatelet treatment. This case suggests that ischemic stroke affecting the cortical knob area, albeit extremely rare, may recur due to a patent foramen ovale, and it necessitates complete investigation, including transesophageal echocardiography, to identify possible embolic sources.

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