Atrial septal defect transcranial doppler ultrasound

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [[2]]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [[4]]

Overview

Trans-cranial doppler ultrasound is a diagnostic tool that involves a simple intravenous injection of saline under minimal sedation. It is primarily utilized to further diagnostically evaluate a patent foramen ovale defect.

Transcranial Doppler Ultrasound

• Transcranial Doppler Ultrasound Bubble test can be used to determine hemodynamic interaction between atriums of the heart
• Non-invasive ultrasound method
• Operated by a hand-held Doppler transducer that functions on a pulsating low-frequency
• Requires no sedation
• Involves a simple intravenous injection of saline solution
• Used as a testing standard in clinical trials of patent foramen ovale closure devices and in studies ivestigating the relationship and interconnectivity of patent foramen ovale, stroke and migraines.

Indications

• Effective in detecting narrowing of cerebral arteries
• Effective in measuring hemodynamic circulation patterns within occluded diseased cerebral arteries
• Effectively measures:

• Peak systolic velocity
• Peak diastolic velocity
• Mean velocity
• Pulsitility

Advantages

• Usage of Valsalva manuever during testing can increase the visibility and overall detection of an atrial septal defect
• Less invasive than other methods
• Cost effective
• Can be completed in under an hour

Common Findings

• A defect may present in two ways:

• Small right-to-left shunt at start of systole (biphasic), associated with patent foramen ovale
• Larger left-to-right shunt, associated primarily with atrial septal defect

• Visualization of bubbles in the left atrium and left ventricle

Supportive Trial Data

• Transcranial Doppler ultrasound Bubble study has minimal or no complications.
• One study which detected an incidence of adverse events of 0.3% or greater and found 0 events; indicating a high confidence interval (alpha value was 0.05).