Right-to-left shunt through a patent foramen ovale was searched for in 80 patients with acute ischemic stroke by simultaneously performing transthoracic two-dimensional echocardiography and transcranial Doppler during agitated saline injection. A patent foramen ovale was detected by echocardiography in 14 patients (17.5%). Transcranial Doppler correctly identified all 14 patients, and 7 more patients in whom echocardiographic findings were indeterminate. Prevalence of patent foramen ovale by transcranial Doppler was therefore 26.3% (21 of 80 patients). Concordance between the two tests was 91.3% (73 of 80 patients). The delivery of contrast material to cerebral vessels is therefore demonstrable by transcranial Doppler in all patients diagnosed by contrast echocardiography, suggesting that paradoxical embolization through a patent foramen ovale may be more frequent than previously thought. Transcranial Doppler with contrast injection is a valid alternative in case of poor echocardiographic image quality.
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Jones HR, Caplan LR, Come PC, Swinton LW, Breslin DJ. Cerebral emboli of paradoxical origin. Ann Neurol 1983; 13: 14–19.
Harvey JR, Teague SM, Anderson JL, Voyles WF, Thadani U. Clinically silent atrial septal defects with evidence for cerebral embolization. Ann Intern Med 1986; 105: 695–97.
Biller J, Johnson MR, Adams HP. Further observations on cerebral or retinal ischemia in patients with right-left intracardiac shunts. Arch Neurol 1987; 44: 740–43.
Webster MWI, Chancellor AM, Smith HJ, Swift DL, Sharpe DN, Bass NM et al. Patent foramen ovale in young stroke patients. Lancet 1988; 2: 11–12.
Lechat P, Mas JL, Lascault G, Loron P, Theard M, Klimczac M et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988; 18: 1148–52.
Falk RH. PFO or UFO? The role of a patent foramen ovale in cryptogenic stroke. Am Heart J 1991; 121: 1264–66.
Shub C, Dimopoulos DN, Seward JB, Callahan JR, Tancredi RG, Schattenberg TT et al. Sensitivity of two-dimensional echocardiography in the direct visualization of atrial septal defect utilizing the subcostal approach: experience with 154 patients. J Am Coll Cardiol 1983; 2: 127–35.
Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1992; (in press) 117: 461–65.
Teague SM, Sharma MK. Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound. Stroke 1991; 22: 740–45.
Hagen PT, Scholz DG, Edwards WD. Incidence and size of patent foramen ovale during the first 10 decades of life: an autopsy study of 965 normal hearts. Mayo Clin Proc 1984; 59: 17–20.
Nemec JJ, Marwick TH, Long RJ, Davison MB, Chimowitz MI, Litowitz H, Salcedo EE. Comparison of transcranial Doppler ultrasound and transesophageal contrast echocardiography in the detection of interatrial right-to-left shunts. Am J Cardiol 1991; 68: 1498–502.
Karnik R, Stollberger C, Valentin A, Winkler WB, Slany J. Detection of patent foramen ovale by transcranial contrast Doppler ultrasound. Am J Cardiol 1992; 69: 560–62.
Mohr JP. Cryptogenic stroke. N Engl J Med 1988; 318: 1197–98.
Rocchini AP. Transcatheter closure of atrial septal defect: past, present and future. Circulation 1990; 82: 751–58.
Borow KM, Karp R. Atrial septal defect: lessons from the past, directions for the future. N Engl J Med 1990; 323: 1698–700.
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Di Tullio, M., Sacco, R.L., Massaro, A. et al. Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients. Int J Cardiac Imag 9, 1–5 (1993). https://doi.org/10.1007/BF01142927
- cerebrovascular disorders
- contrast echocardiography
- foramen ovale
- transcranial Doppler