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Original Paper

Complementarity of Contrast Transcranial Doppler and Contrast Transesophageal Echocardiography for the Detection of Patent Foramen ovale in Stroke Patients

Devuyst G. · Despland P.-A. · Bogousslavsky J. · Jeanrenaud X.

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Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

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Eur Neurol 1997;38:21–25

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 1996
Accepted: December 17, 1996
Published online: December 20, 2007
Issue release date: 1997

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 0

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE

Abstract

All studies concerning the detection of patent foramen ovale (PFO) have compared transthoracic or transesophageal echocardiography (c-TEE) to transcranial Doppler ultrasound after contrast injection (c-TCD), but combining both techniques in the search of PFO has received no consideration. Our study aims to substantiate this claim in 37 patients with cryptogenic stroke. It includes two protocols for the detection of PFO to assess the complementarity of c-TCD and c-TEE performed simultaneously or separately. Firstly, we used a standardized protocol, performing c-TCD alone. Secondly, we used a standardized and a simultaneous protocol which associated c-TCD with c-TEE. When c-TCD and/or c-TEE found right-to-left shunts, they were classified as: minimal, intermediate and massive. c-TCD revealed all PFO detected by c-TEE in 24 patients out of 37 (65%). Furthermore, c-TCD was positive for a PFO in 5 other patients whereas c-TEE was negative. The degree of right-to-left interatrial shunting varied according to the protocol: c-TCD performed alone found 15 massive, 4 intermediate and 5 minimal shunts whereas 10, 9 and 5, respectively, were detected by c-TCD when it was combined with c-TEE. In contrast, c-TEE revealed 8 massive, 8 intermediate and 8 minimal shunts. c-TCD can identify minimal shunts missed by c-TEE and could be more relevant to detect massive shunts, particularly when not performed simultaneously with c-TEE because no sedation is required for c-TCD alone as opposed to c-TEE: thus patients are more cooperative and produce a better Valsalva strain. c-TEE confirms pulmonary shunts suspected by c-TCD and determines the morphologic characteristics of the interatrial septum. While previous studies opposed c-TEE against c-TCD for the detection of a PFO, we think that both techniques are complementary and that it is interesting to associate them, particularly when they are deferred, to increase the ability of detecting PFO and to specify the degree of right-to-left shunting.

© 1997 S. Karger AG, Basel


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: July 09, 1996
Accepted: December 17, 1996
Published online: December 20, 2007
Issue release date: 1997

Number of Print Pages: 5
Number of Figures: 0
Number of Tables: 0

ISSN: 0014-3022 (Print)
eISSN: 1421-9913 (Online)

For additional information: https://www.karger.com/ENE


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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