TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND CONTRAST-TCD IN THE DETECTION OF A PATENT FORAMEN OVALE - EXPERIENCES WITH 111 PATIENTS

被引:149
作者
KLOTZSCH, C [1 ]
JANSSEN, G [1 ]
BERLIT, P [1 ]
机构
[1] ALFRIED KRUPP HOSP,DEPT INTERNAL MED,D-45117 ESSEN,GERMANY
关键词
D O I
10.1212/WNL.44.9.1603
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium (contrast-TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as the ''gold standard,'' the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. Contrast-TCD failed to detect a right-left, shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.
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页码:1603 / 1606
页数:4
相关论文
共 23 条
[1]   2-DIMENSIONAL CONTRAST ECHOCARDIOGRAPHY IN THE DETECTION AND FOLLOW-UP OF CONGENITAL PULMONARY ARTERIOVENOUS-MALFORMATIONS [J].
BARZILAI, B ;
WAGGONER, AD ;
SPESSERT, C ;
PICUS, D ;
GOODENBERGER, D .
AMERICAN JOURNAL OF CARDIOLOGY, 1991, 68 (15) :1507-1510
[2]  
BUSSIERE JP, 1992, ANN MED INTERNE, V143, P5
[3]   DETECTION OF PATENT FORAMEN OVALE BY CONTRAST TRANSESOPHAGEAL ECHOCARDIOGRAPHY [J].
CHEN, WJ ;
KUAN, PL ;
LIEN, WP ;
LIN, FY .
CHEST, 1992, 101 (06) :1515-1520
[4]  
CORRIN B, 1964, BRIT HEART J, V26, P549
[5]   RISK OF PATENT FORAMEN OVALE FOR THROMBOEMBOLIC EVENTS IN ALL AGE-GROUPS [J].
DEBELDER, MA ;
TOURIKIS, L ;
LEECH, G ;
CAMM, AJ .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 69 (16) :1316-1320
[6]  
DEBELDER MA, 1989, CIRCULATION, V80, P340
[7]   COMPARISON OF DIAGNOSTIC-TECHNIQUES FOR THE DETECTION OF A PATENT FORAMEN OVALE IN STROKE PATIENTS [J].
DITULLIO, M ;
SACCO, RL ;
VENKETASUBRAMANIAN, N ;
SHERMAN, D ;
MOHR, JP ;
HOMMA, S .
STROKE, 1993, 24 (07) :1020-1024
[8]   PATENT FORAMEN OVALE AS A RISK FACTOR FOR CRYPTOGENIC STROKE [J].
DITULLIO, M ;
SACCO, RL ;
GOPAL, A ;
MOHR, JP ;
HOMMA, S .
ANNALS OF INTERNAL MEDICINE, 1992, 117 (06) :461-465
[9]   INCIDENCE AND SIZE OF PATENT FORAMEN OVALE DURING THE 1ST 10 DECADES OF LIFE - AN AUTOPSY STUDY OF 965 NORMAL HEARTS [J].
HAGEN, PT ;
SCHOLZ, DG ;
EDWARDS, WD .
MAYO CLINIC PROCEEDINGS, 1984, 59 (01) :17-20
[10]   DIAGNOSIS OF PATENT FORAMEN OVALE BY TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND ASSOCIATION WITH CEREBRAL AND PERIPHERAL EMBOLIC EVENTS [J].
HAUSMANN, D ;
MUGGE, A ;
BECHT, I ;
DANIEL, WG .
AMERICAN JOURNAL OF CARDIOLOGY, 1992, 70 (06) :668-672