Importance of Abdominal Compression Valsalva Maneuver and Microbubble Grading in Contrast Transthoracic Echocardiography for Detecting Patent Foramen Ovale

2020 ◽  
Vol 33 (2) ◽  
pp. 201-206 ◽  
Author(s):  
Yoichi Takaya ◽  
Nobuhisa Watanabe ◽  
Madoka Ikeda ◽  
Teiji Akagi ◽  
Rie Nakayama ◽  
...  
Keyword(s):  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Valsalva Maneuver ◽  
Foramen Ovale ◽  
Abdominal Compression

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.

scholarly journals 479 Usefulness of a new transthoracic echocardiography protocol for identification of patent foramen ovale

2006 ◽  
Vol 7 ◽  
pp. S73-S74
Author(s):  
P CABEZALAINEZ ◽  
A GOMEZMENCHERO ◽  
A CARRILLORUIZ ◽  
R GARCIADELABORBOLLA ◽  
D BARTOLOMEMATEOS ◽  
...  
Keyword(s):  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Foramen Ovale

Abstract 204: Transcranial Doppler Versus Transthoracic Echocardiography for the Detection of Patent Foramen Ovale in Patients With Cryptogenic Cerebral Ischemia: A Systematic Review and Diagnostic Test Accuracy Meta-analysis

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Georgios Tsivgoulis ◽  
Aristeidis H Katsanos ◽  
Theodora Psaltopoulou ◽  
Theodoros Sergentanis ◽  
Alexandra Frogoudaki ◽  
...  
Keyword(s):  
Cerebral Ischemia ◽  
Sensitivity And Specificity ◽  
Transcranial Doppler ◽  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Diagnostic Yield ◽  
Positive Likelihood Ratio ◽  
Receiver Operating Curve ◽  
Test Accuracy ◽  
Foramen Ovale

Background & Purpose: Patent foramen ovale (PFO) can be detected in up to 43% of patients with cryptogenic cerebral ischemia undergoing investigation with transesophageal echocardiography (TEE). The diagnostic value of transthoracic echocardiography (TTE) in the detection of PFO in patients with cryptogenic cerebral ischemia has not been compared with that of transcranial Doppler (TCD) using a comprehensive meta-analytical approach. Methods: We performed a systematic literature review according to PRISMA guidelines to identify all prospective observational studies of patients with cryptogenic cerebral ischemia that provided both sensitivity and specificity measures of TTE, TCD or both compared to the gold standard of TEE. Results: Our literature search identified 35 eligible studies including 3067 patients. The summary sensitivity and specificity for TCD was 96.1% (95% confidence interval: 93.0%-97.8%) and 92.4% (95%CI: 85.5%-96.1%), whereas the respective measures for TTE were 45.1% (95%CI: 30.8-60.3%) and 99.6% (95%CI: 96.5-99.9%). The summary diagnostic odds ratio (DOR) for TCD (DOR=297.97, 95%CI: 131.18-676.83) and TTE (DOR=193.44, 95%CI: 30.38-1231.67) did not significantly differ (z-value=0.418, p=0.676). TTE was superior in terms of higher positive likelihood ratio values (LR+= 106.61, 95%CI: 15.09-753.30 for TTE vs. LR+=12.62, 95%CI: 6.52-24.43 for TCD; p=0.043), while TCD yielded lower negative positive likelihood values (LR- = 0.04, 95%CI: 0.02-0.08) compared to TTE (LR- =0.55, 95%CI: 0.42-0.72; p<0.001). Finally, the area under the summary receiver operating curve was significantly greater (p<0.001) in TCD (AUC=0.98, 95%CI: 0.97-0.99; Figure A) compared to TTE studies (AUC=0.86, 95%CI: 0.82-0.89; Figure B). Conclusions: TCD is more sensitive but less specific compared to TTE for the detection of PFO in patients with cryptogenic cerebral ischemia. The overall diagnostic yield of TCD appears to outweigh that of TTE.

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

OP-035: TRANSTHORACIC ECHOCARDIOGRAPHY GUIDANCE DURING PERCUTANEOUS CLOSURE OF PATENT FORAMEN OVALE

2011 ◽  
Vol 147 ◽  
pp. S46-S47
Author(s):  
E.B. Kaya ◽  
K. Aytemir ◽  
S. Ozkutlu ◽  
H. Yorgun ◽  
A.H. Ates ◽  
...  
Keyword(s):  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Percutaneous Closure ◽  
Foramen Ovale

Exercise after SCUBA diving increases the incidence of arterial gas embolism

2013 ◽  
Vol 115 (5) ◽  
pp. 716-722 ◽  
Author(s):  
Dennis Madden ◽  
Mislav Lozo ◽  
Zeljko Dujic ◽  
Marko Ljubkovic
Keyword(s):  
Transthoracic Echocardiography ◽  
Patent Foramen Ovale ◽  
Maximal Exercise ◽  
Scuba Diving ◽  
Foramen Ovale ◽  
Gas Embolism ◽  
Heavy Equipment ◽  
Pulmonary Microcirculation ◽  
The Right ◽  
Ergometry Test

Arterialization of gas bubbles after decompression from scuba diving has traditionally been associated with pulmonary barotraumas or cardiac defects, such as the patent foramen ovale. Recent studies have demonstrated the right-to-left passage of bubbles through intrapulmonary arterial-venous anastamoses (IPAVA) that allow blood to bypass the pulmonary microcirculation. These passages open up during exercise, and the aim of this study is to see if exercise in a postdiving period increases the incidence of arterialization. After completing a dive to 18 m for 47 min, patent foramen ovale-negative subjects were monitored via transthoracic echocardiography, within 10 min after surfacing, for bubble score at rest. Subjects then completed an incremental cycle ergometry test to exhaustion under continuous transthoracic echocardiography observation. Exercise was suspended if arterialization was observed and resumed when the arterialization cleared. If arterialization was observed a second time, exercise was terminated, and oxygen was administered. Out of 23 subjects, 3 arterialized at rest, 12 arterialized with exercise, and 8 did not arterialize at all even during maximal exercise. The time for arterialization to clear with oxygen was significantly shorter than without. Exercise after diving increased the incidence of arterialization from 13% at rest to 52%. This study shows that individuals are capable of arterializing through IPAVA, and that the intensity at which these open varies by individual. Basic activities associated with SCUBA diving, such as surface swimming or walking with heavy equipment, may be enough to allow the passage of venous gas emboli through IPAVA.

Sign in / Sign up

Export Citation Format

Share Document