Patent foramen ovale echocardiography and ultrasound: Difference between revisions
Jump to navigation
Jump to search
| Line 14: | Line 14: | ||
*Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="MasArquizan2001">{{cite journal|last1=Mas|first1=Jean-Louis|last2=Arquizan|first2=Caroline|last3=Lamy|first3=Catherine|last4=Zuber|first4=Mathieu|last5=Cabanes|first5=Laure|last6=Derumeaux|first6=Geneviève|last7=Coste|first7=Joël|title=Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both|journal=New England Journal of Medicine|volume=345|issue=24|year=2001|pages=1740–1746|issn=0028-4793|doi=10.1056/NEJMoa011503}}</ref> | *Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref><ref name="MasArquizan2001">{{cite journal|last1=Mas|first1=Jean-Louis|last2=Arquizan|first2=Caroline|last3=Lamy|first3=Catherine|last4=Zuber|first4=Mathieu|last5=Cabanes|first5=Laure|last6=Derumeaux|first6=Geneviève|last7=Coste|first7=Joël|title=Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both|journal=New England Journal of Medicine|volume=345|issue=24|year=2001|pages=1740–1746|issn=0028-4793|doi=10.1056/NEJMoa011503}}</ref> | ||
:*Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycles after the complete opacification of the right atrium. | :*Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycles after the complete opacification of the right atrium. | ||
: | :** | ||
*Although tranesopheageal echocardiography is preferred, sedating the patient may cause difficulty in performing the valsalva maneuver.<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref> | *Although tranesopheageal echocardiography is preferred, sedating the patient may cause difficulty in performing the valsalva maneuver.<ref name="pmid15772190">{{cite journal| author=Pinto FJ| title=When and how to diagnose patent foramen ovale. | journal=Heart | year= 2005 | volume= 91 | issue= 4 | pages= 438-40 | pmid=15772190 | doi=10.1136/hrt.2004.052233 | pmc=1768819 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15772190 }} </ref> | ||
Revision as of 20:45, 30 January 2020
|
Patent Foramen Ovale Microchapters |
|
Diagnosis |
|---|
|
Treatment |
|
Case Studies |
|
Patent foramen ovale echocardiography and ultrasound On the Web |
|
American Roentgen Ray Society Images of Patent foramen ovale echocardiography and ultrasound |
|
Patent foramen ovale echocardiography and ultrasound in the news |
|
Blogs on Patent foramen ovale echocardiography and ultrasound |
|
Risk calculators and risk factors for Patent foramen ovale echocardiography and ultrasound |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1];
Overview
Echocardiography/Ultrasound
When diagnosing patent foramen ovale, several echocardiographic techniques can be used, including transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), and transcranial doppler ultrasonography. They all require the use of a contrast, commonly saline solution.[1]
Transesophageal Echocardiography
- Transesophageal echocardiography is the gold standard for diagnosis. It has a superior image resolution and the ability to identify the origin of a right-to-left shunt. It is the study of choice in patients suspected to have a paradoxical embolus.[2][3][1]
- The process of detecting a right-to-left shunt across a PFO involves the patient performing the valsalva maneuver while injected with a saline contrast medium. During the strain phase of the maneuver, the saline medium is injected into a peripheral vein and the atrial septum is visualized during the release phase of the maneuver.[3]
- Findings on an echocardiography suggestive of/diagnostic of a right-to-left shunt include:[3][4]
- Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycles after the complete opacification of the right atrium.
- Presence of bubbles across the inter-atrial septum into the left atrium: A diagnosis is made with the appearance of at least three micro-bubbles within three cardiac cycles after the complete opacification of the right atrium.
- Although tranesopheageal echocardiography is preferred, sedating the patient may cause difficulty in performing the valsalva maneuver.[3]
Transthoracic Echocardiography
- A standard TTE should precede a contrast-enhanced TEE in a workup for cryptogenic shock. The presence of a patent foramen ovale should be further assessed with a contrast-enhanced TEE if the result reveals a structurally normal heart and an intra-cardiac sources of emboli.[1]
- It is a very specific technique that has the ability to detect a large right-to-left shunt.[5]
Transcranial Doppler Ultrasonography
- It is a reliable and non-invasive test useful for cryptogenic stroke work-up and consideration for patent foramen ovale closure.[1]
- It can be used as an alternative to contrast enhanced transesophageal echocardiography in recognizing a right-to-left shunt because of its excellent diagnostic accuracies.[6]
- From a meta-analysis, transcranial doppler had a mean sensitivity and specificity of 97% and 93%, respectively.[6]
References
- ↑ 1.0 1.1 1.2 1.3 Falanga G, Carerj S, Oreto G, Khandheria BK, Zito C (2014). "How to Understand Patent Foramen Ovale Clinical Significance: Part I." J Cardiovasc Echogr. 24 (4): 114–121. doi:10.4103/2211-4122.147202. PMC 5353567. PMID 28465918.
- ↑ Pearson AC, Labovitz AJ, Tatineni S, Gomez CR (1991). "Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology". J Am Coll Cardiol. 17 (1): 66–72. doi:10.1016/0735-1097(91)90705-e. PMID 1987242.
- ↑ 3.0 3.1 3.2 3.3 Pinto FJ (2005). "When and how to diagnose patent foramen ovale". Heart. 91 (4): 438–40. doi:10.1136/hrt.2004.052233. PMC 1768819. PMID 15772190.
- ↑ Mas, Jean-Louis; Arquizan, Caroline; Lamy, Catherine; Zuber, Mathieu; Cabanes, Laure; Derumeaux, Geneviève; Coste, Joël (2001). "Recurrent Cerebrovascular Events Associated with Patent Foramen Ovale, Atrial Septal Aneurysm, or Both". New England Journal of Medicine. 345 (24): 1740–1746. doi:10.1056/NEJMoa011503. ISSN 0028-4793.
- ↑ Zito C, Dattilo G, Oreto G, Di Bella G, Lamari A, Iudicello R; et al. (2009). "Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke and migraine". Echocardiography. 26 (5): 495–503. doi:10.1111/j.1540-8175.2008.00852.x. PMID 19452605.
- ↑ 6.0 6.1 Mojadidi MK, Roberts SC, Winoker JS, Romero J, Goodman-Meza D, Gevorgyan R; et al. (2014). "Accuracy of transcranial Doppler for the diagnosis of intracardiac right-to-left shunt: a bivariate meta-analysis of prospective studies". JACC Cardiovasc Imaging. 7 (3): 236–50. doi:10.1016/j.jcmg.2013.12.011. PMID 24560213.