Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 5 , Pages 343-348 , September 2009

Transcranial Doppler and Transesophageal Echocardiography: Comparison of Both Techniques and Prospective Clinical Relevance of Transcranial Doppler in Patent Foramen Ovale Detection

  • Luigi Caputi, MD

      Affiliations

    • Fondazione IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Istituto Neurologico C. Besta Milan, Italy
    • Corresponding Author InformationAddress correspondence to Luigi Caputi, MD, Fondazione IRCCS (Scientific Institute for research, hospitalization and healthcare) Istituto Neurologico C. Besta, Via Celoria 11, 20133 Milan, Italy.
    • ,
  • Maria Rita Carriero, MD

      Affiliations

    • Fondazione IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Istituto Neurologico C. Besta Milan, Italy
    • ,
  • Chiara Falcone, MSc

      Affiliations

    • Fondazione IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Istituto Neurologico C. Besta Milan, Italy
    • ,
  • Eugenio Parati, MD

      Affiliations

    • Fondazione IRCCS (Scientific Institute for Research, Hospitalization and Healthcare) Istituto Neurologico C. Besta Milan, Italy
    • ,
  • Patrizia Piotti, MD

      Affiliations

    • Cardiology Unit, National Cancer Institute Milan, Italy
    • ,
  • Carlo Materazzo, MD

      Affiliations

    • Cardiology Unit, National Cancer Institute Milan, Italy
    • ,
  • Gian Paolo Anzola, MD

      Affiliations

    • Service of Neurology, S. Orsola Hospital FB (Fatebenefratelli), Brescia, Italy

Received 15 April 2008 ,Revised 4 December 2008 ,Accepted 16 December 2008.

References 

  1. 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
  2. McGaw D, Harper R. Patent foramen ovale and cryptogenic cerebral infarction [review]. Intern Med J. 2001;31:42–47
  3. Overell JR, Bone I, Lees KR. Interatrial septal abnormalities and stroke: A meta-analysis of case-control studies. Neurology. 2000;24:1172–1179
  4. Cabanes L, Mas JL, Cohen A, et al. Atrial septal aneurysm and patent foramen ovale as risk factors for cryptogenic stroke in patients less than 55 years of age: A study using transesophageal echocardiography. Stroke. 1993;24:1865–1873
  5. Di Tullio M, Sacco RL, Gopal A, et al. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med 1192;15:461–465.
  6. Ranoux D, Cohen A, Cabanes L, et al. Patent foramen ovale: Is stroke due to paradoxical embolism?. Stroke. 1993;24:31–34
  7. Anzola GP, Magoni M, Guindani M, et al. Potential source of cerebral embolism in migraine with aura: A transcranial Doppler study. Neurology. 1999;12:1622–1625
  8. Sztajzel R, Genoud D, Roth S, et al. Patent foramen ovale, a possible cause of symptomatic migraine: A study of 74 patients with acute ischemic stroke. Cerebrovasc Dis. 2002;13:102–106
  9. Sorrentino M, Resnekov L. Patent foramen ovale associated with platypnea and orthodeoxia. Chest. 1991;100:1157–1158
  10. Germonpre P. Patent foramen ovale and diving. Cardiol Clin. 2005;23:97–104
  11. Knauth M, Ries S, Pohimann S, et al. Cohort study of multiple brain lesions in sport divers: Role of a patent foramen ovale. BMJ 1197;8:701-705.
  12. Stendel R, Gramm HJ, Schroeder K, et al. Transcranial Doppler ultrasonography as a screening technique for detection of a patent foramen ovale before surgery in the sitting position. Anesthesiology. 2000;93:971–975
  13. Schneider B, Zienkiewicz T, Jansen V, et al. Diagnosis of patent foramen ovale by transesophageal echocardiography and correlation with autopsy findings. Am J Cardiol. 1996;1:1202–1209
  14. Hausmann D, Mugge A, Becht I, et al. Diagnosis of patent foramen ovale by transesophageal echocardiography and association with cerebral and peripheral embolic events. Am J Cardiol. 1992;1:668–672
  15. Pearson AC, Labovitz AJ, Tatineni S, et al. Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology. J Am Coll Cardiol. 1991;17:66–72
  16. Ofili EO, Rich MW. Safety and usefulness of transesophageal echocardiography in persons aged greater than or equal to 70 years. Am J Cardiol. 1990;15:1279–1280
  17. Zabalgoitia M, Norris LP, Garcia M. Atrial septal aneurysm as a potential source of neurological ischemic events [review]. Am J Card Imaging. 1994;8:39–44
  18. Fisher DC, Fisher EA, Budd JH, et al. The incidence of patent foramen ovale in 1,000 consecutive patients: A contrast transesophageal echocardiography study. Chest. 1995;107:1504–1509
  19. Chimowitz MI, Nemec JJ, Marwick TH, et al. Transcranial Doppler ultrasound identifies patients with right-to-left cardiac or pulmonary shunts. Neurology. 1991;41:1902–1904
  20. Di Tullio M, Sacco RL, Massaro A, et al. Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients. Int J Card Imaging. 1993;9:1–5
  21. Jauss M, Kaps M, Keberle M, et al. A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium for detection of patent foramen ovale. Stroke. 1994;25:1265–1267
  22. Job FP, Ringelstein EB, Grafen Y, et al. Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients. Am J Cardiol. 1994;15:381–384
  23. Droste DW, Kriete JU, Stypmann J, et al. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: Comparison of different procedures and different contrast agents. Stroke. 1999;30:1827–1832
  24. Devuyst G, Despland PA, Bogousslavsky J, et al. Complementarity of contrast transcranial Doppler and contrast transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur Neurol. 1997;38:21–25
  25. Horner S, Ni XS, Weihs W, et al. Simultaneous bilateral contrast transcranial Doppler monitoring in patients with intracardiac and intrapulmonary shunts. J Neurol Sci. 1997;1:49–57
  26. Anzola GP, Renaldini E, Magoni M, et al. Validation of transcranial Doppler sonography in the assessment of patent foramen ovale. Cerebrovasc Dis. 1995;5:194–198
  27. Droste DW, Reisener M, Kemeny V, et al. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: Reproducibility, comparison of 2 agents, and distribution of microemboli. Stroke. 1999;30:1014–1018
  28. Jauss M, Zanette E. Detection of right-to-left shunt with ultrasound contrast agent and transcranial Doppler sonography. Cerebrovasc Dis. 2000;10:490–496
  29. Schwarze JJ, Sander D, Kukla C, et al. Methodological parameters influence the detection of right-to-left shunts by contrast transcranial Doppler ultrasonography. Stroke. 1999;30:1234–1239
  30. Di Tullio MR, Sacco RL, Venketasubramanian N, et al. Comparison of diagnostic techniques for the detection of a patent foramen ovale in stroke patients. Stroke. 1993;24:1020–1024
  31. Pearson A, Nagelhout D, Castello R, et al. Atrial septal aneurysm and stroke: A transesophageal study. J Am Coll Cardiol. 1991;18:1223–1229
  32. Del Sette M, Angeli S, Leandri M, et al. Migraine with aura and right-to-left shunt on transcranial Doppler: A case-control study. Cerebrovasc Dis. 1998;8:327–330
  33. Dalla Volta G, Guindani M, Zavarise P, et al. Prevalence of patent foramen ovale in a large series of patients with migraine with aura, migraine without aura and cluster headache, and relationship with clinical phenotype. J Headache Pain. 2005;6:328–330
  34. Kimura K, Minematsu K, Wada K, et al. Transcranial Doppler of a paradoxical brain embolism associated with a pulmonary arteriovenous fistula. AJNR Am J Neuroradiol. 1999;20:1881–1884
  35. Marquez J, Sladen A, Gendell H, et al. Paradoxical cerebral air embolism without an intracardiac septal defect: Case report. J Neurosurg. 1981;55:997–1000
  36. Natarajan K, Khabiri H, Jung S. Case 3, pulmonary arteriovenous malformation (PAVM): Paradoxical embolism through the arteriovenous fistula can cause brain abscess and infarct. AJR Am J Roentgenol. 2000;175:854–858
  37. Zanette EM, Mancini G, De Castro S, et al. Patent foramen ovale and transcranial Doppler: Comparison of different procedures. Stroke. 1996;27:2251–2255
  38. Venketasubramanian N, Sacco RL, Di Tullio M, et al. Vascular distribution of paradoxical emboli by transcranial Doppler. Neurology. 1993;43:1533–1535
  39. Droste DW, Lakemeier H, Ritter M, et al. The identification of right-to-left shunts using contrast transcranial Doppler ultrasound: Performance and interpretation modalities, and absence of a significant side difference of cardiac micro-emboli. Neurol Res. 2004;26:325–330
  40. Souteyrand G, Motreff P, Lusson JR, et al. Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients. Eur J Echocardiogr. 2006;7:147–154
  41. De Castro S, Caselli S, Papetti F, et al. Feasibility and clinical impact of live three-dimensional echocardiography in the management of congenital heart disease. Echocardiography. 2006;23:553–561
  42. Isayev Y, Chan RK, Pullicino PM. “Economy class” stroke syndrome?. Neurology. 2002;26:960–961

PII: S1052-3057(08)00283-8

doi: 10.1016/j.jstrokecerebrovasdis.2008.12.001

Journal of Stroke & Cerebrovascular Diseases
Volume 18, Issue 5 , Pages 343-348 , September 2009

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