scholarly journals The Value of Contrast-Enhanced Transesophageal Echocardiography in the Detection of Cardiac Right-to-Left Shunt Related with Cryptogenic Stroke and Migraine

2020 ◽  
Vol 2020 ◽  
pp. 1-5
Author(s):  
Huiqin Zhang ◽  
Wenyan Huang ◽  
Tingyu Lan ◽  
Meng Zhang ◽  
Jing Yang ◽  
...  
Keyword(s):  
Transesophageal Echocardiography ◽  
Arteriovenous Fistula ◽  
Left Atrium ◽  
Cryptogenic Stroke ◽  
Pulmonary Arteriovenous Fistula ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Stroke Group ◽  
Migraine Group ◽  
Grade 3

Purpose. To analyze the characteristics of right-to-left shunt (RLS) in patients with cryptogenic stroke and migraine by contrast-enhanced transesophageal echocardiography (c-TEE). Methods. The study population consisted of 330 patients with cryptogenic stroke and 330 patients with migraine who suspected PFO. All of them received c-TEE examination successfully. In terms of c-TEE analyses, RLS could be diagnosed when microbubbles were visualized in the transition from the right atrium to the left atrium. For semiquantitative analysis, a small amount of RLS was grade 1, indicating 1-10 microvesicles per frame could be seen in the left atrium, a moderate amount of RLS was grade 2, indicating 11-30 microvesicles per frame could be seen in the left atrium, and a large amount of RLS was grade 3, indicating more than 30 microvesicles per frame, or the left atrium is filled with microvesicles. Results. A total of 660 patients were analyzed in the study. PFO-RLS was detected in 348 (348/660, 52.7%) cases by TEE, while in 392 (392/660, 59.3%) cases by c-TEE. Simultaneously, P-RLS was detected in 239 (239/660, 36.2%) cases by c-TEE. Among 330 patients with cryptogenic stroke, PFO-RLS was detected in 198 cases; according to the c-TTE method (198/330, 60.0%), concurrently, 83 participants suffered from PFO-RLS and P-RSL (83/330, 25.1%), including 1 case with PFO and pulmonary arteriovenous fistula. Among 330 patients with migraine, PFO-RLS was detected in 194 cases; according to the c-TTE method (194/330, 58.7%), specifically, 90 participants suffered from PFO-RLS and P-RSL (90/330, 27.2%). There was no statistical significance between the two groups. P-RLS singly was detected in 28 cases with cryptogenic stroke, while in 38 cases with migraine, excluding from pulmonary arteriovenous fistula by CTA examination. In addition, semiquantitative results on c-TTE grading of RLS were compared between the two groups: grade 1 RLS in the migraine group (144/322) was significantly higher than that in the cryptogenic stroke group (71/309) ( P < 0.05 ). Grade 3 RLS in the cryptogenic stroke group (113/309) was significantly higher than that in the migraine group (67/322) ( P < 0.05 ). For grade 2 RLS, there was no statistical difference between the two groups ( P = 0.12 ). Conclusions. c-TEE can increase the positive rate of PFO diagnosis compared with TEE color Doppler. There is no significant difference in the incidence of PFO-PLS and P-RLS between the cryptogenic stroke group and the migraine group. The grades 2-3 RLS are mainly detected in the cryptogenic stroke group, while grades 1-2 RLS are mostly detected in the migraine group.

scholarly journals Right-to-left shunt and the hypercoagulable state: does paradoxical embolism play a role in patients with antiphospholipid syndrome and stroke?

2012 ◽  
Vol 70 (8) ◽  
pp. 578-582 ◽  
Author(s):  
Laura Nicoleti Zamproni ◽  
Viviane Flumignan Zétola ◽  
Marcos Christiano Lange
Keyword(s):  
Antiphospholipid Syndrome ◽  
Transcranial Doppler ◽  
High Intensity ◽  
Patent Foramen Ovale ◽  
Paradoxical Embolism ◽  
Foramen Ovale ◽  
Contrast Enhanced ◽  
Significant Difference ◽  
Stroke Group ◽  
History Of

OBJECTIVE: Patent foramen ovale is associated with paradoxical embolism (PE) and stroke. Hypercoagulable states, such as antiphospholipid syndrome (APS), can exacerbate PE by increasing clot formation. The aim of this study was to verify whether patients with APS and stroke present a right-to-left shunt (RLS) with greater frequency than patients with APS but without stroke. METHODS: Fifty-three patients with APS were tested for RLS using contrast-enhanced transcranial Doppler (cTCD): 23 patients had a history of stroke (Stroke Group) and 30 had no history of stroke (No-stroke Group). RESULTS: cTCD was positive in 15 patients (65%) from the Stroke Group and in 16 patients (53%) in the No-stroke Group (p=0.56). The proportion of patients with a small RLS (<10 high-intensity transient sign or HITS) and a large RLS (>10 HITS) was similar between the groups without significant difference. CONCLUSIONS: Our data do not support the theory that paradoxical embolism may play an important role in stroke in APS patients.

scholarly journals Bubbles in a Row: Finding of Pulmonary Arteriovenous Fistula on Transesophageal Echocardiography

2013 ◽  
Vol 21 (1) ◽  
pp. 42
Author(s):  
Yong Hyun Park ◽  
Jeong Su Kim ◽  
Jun Kim ◽  
June Hong Kim ◽  
Kook Jin Chun
Keyword(s):  
Transesophageal Echocardiography ◽  
Arteriovenous Fistula ◽  
Pulmonary Arteriovenous Fistula

Pulmonary Arteriovenous Fistula Drainage into the Left Atrium

2000 ◽  
Vol 48 (1) ◽  
pp. 37-39 ◽  
Author(s):  
Th. Tirilomis ◽  
Th. Busch ◽  
I. Aleksic ◽  
W. Ruschewski ◽  
C.-P. Criée ◽  
...  
Keyword(s):  
Arteriovenous Fistula ◽  
Left Atrium ◽  
Pulmonary Arteriovenous Fistula

scholarly journals Recurrent Stroke in a Young Woman with a Single Pulmonary Arteriovenous Fistula: An Unusual Association

2017 ◽  
Vol 9 (3) ◽  
pp. 293-298 ◽  
Author(s):  
Sandra Sousa ◽  
Nuno Vasco Costa ◽  
Cátia Carmona ◽  
Élia Coimbra ◽  
Fernando Pita
Keyword(s):  
Arteriovenous Fistula ◽  
Young Woman ◽  
Brain Mri ◽  
Cryptogenic Stroke ◽  
Stroke Recurrence ◽  
Pulmonary Arteriovenous Fistula ◽  
Ischemic Lesion ◽  
Pulmonary Angiogram ◽  
Therapeutic Decisions ◽  
History Of

Introduction: Cryptogenic stroke is present in about 40% of ischemic stroke patients. Extracardiac shunt related to pulmonary arteriovenous fistula (PAVF) could be a rare potential risk factor for embolic stroke. Most PAVFs are multiple, congenital, and associated with hereditary conditions. On the other hand, isolated PAVFs are rare conditions and an uncommon cause of cryptogenic stoke. Case Report: We describe a case of a young woman without history of respiratory diseases or vascular risk factors, who presented with acute onset of transitory aphasia and right hemiplegia. She had a history of a transient ischemic attack, 3 years before, and migraine headaches. Brain MRI showed an acute cortical ischemic lesion and a chronic ischemic lesion. Diagnostic workup with transcranial Doppler ultrasonography revealed a significant right-to-left shunt with curtain pattern, and echocardiogram did not show structural abnormalities. An isolated small PAVF was diagnosed on pulmonary angiogram. Despite the rare association between isolated small PAVF and stroke, we decided to treat it with coil embolization because of recurrence of stroke, cortical lesions suggestive of embolic source, significant right-left shunt, and risk of future complications. Conclusions: This case highlights the importance of search, identification, and interpretation of causes of cryptogenic strokes to better choose therapy to reduce the stroke recurrence risk. Although unusual, PAVF detection is a treatable cause of stroke and the therapeutic decisions should take into account the characteristics of the PAVF and the degree of suspicion regarding the cause-effect relationship between PAVF and stroke.

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.

Pulmonary arteriovenous fistula in a patient with cryptogenic stroke

Heart ◽  
2011 ◽  
Vol 97 (24) ◽  
pp. 2093-2093 ◽  
Author(s):  
K. T. Ahn ◽  
J.-H. Choi ◽  
S. W. Park
Keyword(s):  
Arteriovenous Fistula ◽  
Cryptogenic Stroke ◽  
Pulmonary Arteriovenous Fistula

Positive correlation between neovascularization degree of carotid atherosclerosis determined by contrast-enhanced ultrasound and level of serum C-reactive protein

VASA ◽  
2015 ◽  
Vol 44 (3) ◽  
pp. 0187-0194 ◽  
Author(s):  
Xiaoni Chang ◽  
Jun Feng ◽  
Litao Ruan ◽  
Jing Shang ◽  
Yanqiu Yang ◽  
...  
Keyword(s):  
Contrast Enhancement ◽  
Rank Correlation ◽  
Artery Stenosis ◽  
Contrast Enhanced Ultrasound ◽  
C Reactive Protein ◽  
Protein Levels ◽  
Reactive Protein ◽  
Contrast Enhanced ◽  
Grade 3 ◽  
Axis View

Background: Neovascularization is one of the most important risk factors for unstable plaque. This study was designed to correlate plaque thickness, artery stenosis and levels of serum C-reactive protein with the degree of intraplaque enhancement determined by contrast-enhanced ultrasound. Patients and methods: Contrast-enhanced ultrasound was performed on 72 carotid atherosclerotic plaques in 48 patients. Contrast enhancement within the plaque was categorized as grade 1, 2 or 3. Maximum plaque thickness was measured in short-axis view. Carotid artery stenosis was categorized as mild, moderate or severe. Results: Plaque contrast enhancement was not associated with the degree of artery stenosis or with plaque thickness. Serum C-reactive protein levels were positively correlated with the number of new vessels in the plaque. C-reactive protein levels increased in the three groups(Grade 1: 3.72±1.79mg/L; Grade 2: 7.88±4.24 mg/L; Grade 3: 11.02±3.52 mg/L), with significant differences among them (F=10.14, P<0.01), and significant differences between each two groups (P<0.05). Spearman’s rank correlation analysis showed that serum C-reactive protein levels were positively correlated with the degree of carotid plaque enhancement (Rs =0.69, P<0.01). Conclusions: The combination of C-reactive protein levels and intraplaque neovascularization detected by contrast-enhanced ultrasound may allow more accurate evaluation of plaque stability.

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