1
|
Kanemaru K, Ueno Y, Kikuno M, Tateishi Y, Shimizu T, Kuriki A, Doijiri R, Takekawa H, Shimada Y, Yamaguchi E, Koga M, Kamiya Y, Ihara M, Tsujino A, Hirata K, Hasegawa Y, Aizawa H, Hattori N, Urabe T. High-risk patent foramen ovale and elderly in cryptogenic stroke. J Stroke Cerebrovasc Dis 2023; 32:107344. [PMID: 37722223 DOI: 10.1016/j.jstrokecerebrovasdis.2023.107344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2023] [Revised: 08/29/2023] [Accepted: 09/05/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND High-risk patent foramen ovale (PFO) could be pathological in cryptogenic stroke (CS), but its clinical characteristics have not been fully studied, especially in elderly patients. METHODS Patients with CS were enrolled in the CHALLENGE ESUS/CS registry, a multicenter registry of CS patients undergoing transesophageal echocardiography. Clinical characteristics were compared among three groups: high-risk PFO group, large shunt PFO (≥25 microbubbles) or PFO with atrial septal aneurysm (ASA); right-to-left shunt (RLS) group, RLS including PFO with <25 microbubbles or without ASA; and no-RLS group. RESULTS In total, 654 patients were analyzed: 91, 221, and 342 in the high-risk PFO, RLS, and no-RLS groups, respectively. In multinomial logistic regression analysis, the male sex (odds ratio [OR] 1.825 [1.067-3.122]) was independently associated with high-risk PFO, but hypertension (OR, 0.562 [0.327-0.967]), multiple infarctions (OR, 0.601 [0.435-0.830]), and other cardioaortic embologenic risks (OR, 0.514 [0.294-0.897]) were inversely associated with high-risk PFO compared with non-RLS. In 517 patients aged ≥60 years, multiple infarctions (OR, 0.549 [0.382-0.788]) and other cardioaortic embologenic risks (OR, 0.523 [0.286-0.959]) were inversely associated with high-risk PFO. CONCLUSIONS High-risk PFO had specific clinical characteristics and possible mechanistic associations, and this trend was consistent among CS patients aged ≥60 years. CLINICAL TRIAL REGISTRATION INFORMATION http://www.umin.ac.jp/ctr/ (UMIN000032957).
Collapse
Affiliation(s)
- Kodai Kanemaru
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yuji Ueno
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan.
| | - Muneaki Kikuno
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan; Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Yohei Tateishi
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Takahiro Shimizu
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Ayako Kuriki
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Ryosuke Doijiri
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | | | - Yoshiaki Shimada
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| | - Eriko Yamaguchi
- Department of Neurology, Iwate Prefectural Central Hospital, Iwate, Japan
| | - Masatoshi Koga
- Department of Cerebrovascular Medicine, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Yuki Kamiya
- Department of Neurology, Showa University Koto Toyosu Hospital, Tokyo, Japan
| | - Masafumi Ihara
- Department of Neurology, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Akira Tsujino
- Department of Neurology and Strokology, Nagasaki University Hospital, Nagasaki, Japan
| | - Koichi Hirata
- Department of Neurology, Dokkyo Medical University, Tochigi, Japan
| | - Yasuhiro Hasegawa
- Department of Neurology, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Hitoshi Aizawa
- Department of Neurology, Tokyo Medical University Hospital, Tokyo, Japan
| | - Nobutaka Hattori
- Department of Neurology, Juntendo University Faculty of Medicine, Tokyo, Japan
| | - Takao Urabe
- Department of Neurology, Juntendo University Urayasu Hospital, Chiba, Japan
| |
Collapse
|
2
|
Zhang H, Liu W, Ma J, Liu H, Li L, Zhou J, Wang S, Li S, Wang W, Wang Y. Pitfalls of Using Imaging Technique in the Presence of Eustachian Valve or Chiari Network: Effects on Right-to-Left Shunt and Related Influencing Factors. Diagnostics (Basel) 2022; 12:diagnostics12102283. [PMID: 36291972 PMCID: PMC9600541 DOI: 10.3390/diagnostics12102283] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/20/2022] [Indexed: 11/16/2022] Open
Abstract
When patent foramen ovale (PFO) combines with the prominent Eustachian valve or Chiari network (EV/CN), contrast transthoracic echocardiography (cTTE) may miss the diagnosis of PFO. We sought to determine the characteristics of right-to-left shunt (RLS) in PFO patients with prominent EV/CN on cTTE and identify the causal factors of missed diagnosis. We consecutively enrolled 98 patients who suffered from PFO-related stroke and with prominent EV/CN. All patients were divided into the delayed and non-delayed groups according to the characteristics of RLS on cTTE. The characteristics of RLS were compared with those of 42 intrapulmonary shunt patients. The anatomical characteristics of PFO and EV/CN were analyzed in the 98 PFO patients. Upon cTTE, significantly delayed occurrence and longer duration of the RLS in the delayed group were found both at rest and during the Valsalva maneuver, similar to the intrapulmonary shunt. Multivariate logistic analysis revealed that the length of EV/CN (>19 mm) and the diameter of PFO at the left atrium aspect (<1.2 mm) were high-risk factors for missed diagnosis. In conclusion, RLS showed delayed emergence and disappearance in some of the PFO patients with prominent EV/CN. The length of EV/CN and the diameter of PFO may have been related to the missed diagnosis of PFO.
Collapse
Affiliation(s)
- Han Zhang
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Weiwei Liu
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Jie Ma
- Department of Vascular Surgery, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Huanling Liu
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Lin Li
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Jinling Zhou
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Shanshan Wang
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Shanshan Li
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Wei Wang
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
| | - Yueheng Wang
- Department of Cardiac Ultrasound, The Second Hospital of Hebei Medical University, Shijiazhuang 050000, China
- Correspondence: ; Tel.: +86-0311-6600-3733
| |
Collapse
|
3
|
Parrini I, Cecchi E, Forno D, Lyon AR, Asteggiano R. Device closure for patent foramen ovale in patients with cryptogenic stroke: which patients should get it? Eur Heart J Suppl 2021; 22:M43-M50. [PMID: 33664639 PMCID: PMC7916420 DOI: 10.1093/eurheartj/suaa163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Patent foramen ovale (PFO) and cryptogenic stroke (CS) both have a high prevalence. The optimal treatment to reduce stroke recurrence after CS remains controversial. Results from clinical trials, meta-analyses, and position papers, support percutaneous PFO device closure and medical therapy compared to medical therapy alone. However, the procedure may be associated with cardiac complications including an increased incidence of new atrial fibrillation. The benefit/risk balance should be determined on a case-by-case basis with the greatest benefit of PFO closure in patients with atrial septal aneurysm and PFO with large shunts. Future studies should address unsolved questions such as the choice of medical therapy in patients not undergoing closure, the duration of antiplatelet therapy, and the role of PFO closure in patients over 60 years old.
Collapse
Affiliation(s)
- Iris Parrini
- Division of Cardiology, Mauriziano Hospital Turin, Italy
| | - Enrico Cecchi
- Division of Cardiology, MariaVittoria Hospital Turin, Italy
| | - Davide Forno
- Division of Cardiology, MariaVittoria Hospital Turin, Italy
| | - Alexander R Lyon
- Department of Cardiology, Royal Brompton Hospital and Imperial College London, SW3 6NP, UK
| | - Riccardo Asteggiano
- LARC (Laboratorio Analisi e Ricerca Clinica) C.so Venezia 10-Turin - Italy and School of Medicine-, Insubria University, Varese, Italy
| |
Collapse
|
4
|
Boukhris M, Masson JB, Potvin J. Challenging Diagnosis of Patent Foramen Ovale in Presence of a Large Eustachian Valve. J Saudi Heart Assoc 2021; 33:135-137. [PMID: 34183910 PMCID: PMC8143726 DOI: 10.37616/2212-5043.1249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 03/20/2021] [Accepted: 03/21/2021] [Indexed: 11/21/2022] Open
Abstract
We report the case of a 39-year-old woman who presented with cryptogenic stroke. Conventional and contrast echocardiography modalities noticed a large Eustachian valve (EV) but failed to identify any right-to-left shunt. Conversely, contrast-transcranial Doppler revealed a grade 3 right-to-left shunt. Contrast echocardiography was repeated with bubble injections through both an upper extremity and a femoral vein, 10 min apart from each other. While no shunt was observed following upper extremity injection, >20 bubbles crossed the inter-atrial septum when contrast was injected via femoral vein confirming the diagnosis of patent foramen ovale.
Collapse
Affiliation(s)
- Marouane Boukhris
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jean-Bernard Masson
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| | - Jeannot Potvin
- Division of Cardiology, Centre Hospitalier de L'Université de Montréal (CHUM), Montréal, Québec, Canada
| |
Collapse
|
5
|
Bruce L, Gunston G, Myburgh A, Keet K, Augoustides JG, Pulton DA, Thalappillil R, Rong LQ, Garner C, Fernando RJ. The Anatomy of the Eustachian Valve-Navigating the Implications for Right-Sided Surgical and Transcatheter Cardiac Interventions. J Cardiothorac Vasc Anesth 2020; 35:1215-1224. [PMID: 33455884 DOI: 10.1053/j.jvca.2020.12.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 12/09/2020] [Indexed: 02/06/2023]
Affiliation(s)
- Louren Bruce
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Geney Gunston
- Division of Clinical Anatomy and Biological Anthropology, Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Adriaan Myburgh
- Department of Anesthesia and Perioperative Medicine, Groote Schuur Hospital, Cape Town, South Africa
| | - Kerri Keet
- Division of Clinical Anatomy, Department of Biomedical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - John G Augoustides
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Danielle A Pulton
- Cardiovascular and Thoracic Division, Department of Anesthesiology and Critical Care, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY
| | - Chandrika Garner
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| | - Rohesh J Fernando
- Cardiothoracic Section, Department of Anesthesiology, School of Medicine, Wake Forest University, Winston Salem, NC
| |
Collapse
|
6
|
Montrief T, Alerhand S, Denault A, Scott J. Point-of-care echocardiography for the evaluation of right-to-left cardiopulmonary shunts: a narrative review. Can J Anaesth 2020; 67:1824-1838. [PMID: 32944839 DOI: 10.1007/s12630-020-01813-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 12/19/2022] Open
Abstract
Right-to-left pulmonary and cardiac shunts (RLS) are important causes of refractory hypoxia in the critically-ill perioperative patient. Using a point-of-care ultrasound (POCUS) agitated saline bubble study for an early diagnosis allows patients with clinically significant RLSs to receive expedited therapy. This narrative review discusses the principles of agitated saline ultrasonography as well as the role of POCUS in detecting the most common RLS types seen in the intensive care unit, including patent foramen ovale, atrial septal defects, and pulmonary arterio-venous malformations. An illustrated discussion of the procedure, as well as shunt-enhancing maneuvers (Valsalva or lung recruitment maneuver with subsequent rapid release) is provided. With the wide dissemination of bedside ultrasound within the perioperative and critical care arena, POCUS practitioners should be knowledgeable of the potential pitfalls leading to both false-positive and false-negative studies. False-positive studies may be due to congenital abnormalities, mischaracterization of intrapulmonary shunts as intracardiac shunts (and vice versa), or evidence of the Valsalva effect. False negatives are typically due to respiratory-phasic variation, performing an inadequate shunt-enhancing maneuver, inadequate injection of agitated saline, or pathophysiologic states of elevated left atrial pressure. Finally, alternative POCUS methods for determining presence of an RLS in patients with poor echocardiographic windows are discussed, with a focus on pulsed-wave Doppler interrogation of arterial signals.
Collapse
Affiliation(s)
- Tim Montrief
- Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, USA
| | - André Denault
- Department of Anesthesiology and Critical Care Division, Montreal Heart Institute, Université de Montréal, 5000 Belanger Street, Montreal, QC, H1T 1C8, Canada.
| | - Jeffrey Scott
- Division of Cardiothoracic and Transplant Critical Care, Jackson Health System, Miami Transplant Institute, Miami, FL, USA
| |
Collapse
|
7
|
Cai Q, Ahmad M. Eustachian valve, interatrial shunt, and paradoxical embolism. Echocardiography 2020; 37:939-944. [DOI: 10.1111/echo.14682] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Revised: 04/11/2020] [Accepted: 04/20/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Qiangjun Cai
- Division of Cardiology University of Texas Medical Branch Galveston TX USA
| | - Masood Ahmad
- Division of Cardiology University of Texas Medical Branch Galveston TX USA
| |
Collapse
|
8
|
Cor triatriatum dexter associated with atrial septal defect and mitral valve regurgitation. J Echocardiogr 2019; 19:118-120. [PMID: 31549368 DOI: 10.1007/s12574-019-00444-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2018] [Revised: 08/30/2019] [Accepted: 09/16/2019] [Indexed: 12/15/2022]
|
9
|
Vitarelli A. Patent Foramen Ovale: Pivotal Role of Transesophageal Echocardiography in the Indications for Closure, Assessment of Varying Anatomies and Post-procedure Follow-up. ULTRASOUND IN MEDICINE & BIOLOGY 2019; 45:1882-1895. [PMID: 31104864 DOI: 10.1016/j.ultrasmedbio.2019.04.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 03/09/2019] [Accepted: 04/12/2019] [Indexed: 06/09/2023]
Abstract
Patent foramen ovale (PFO) is present in 15%-30% of the general population and has been associated with various pathologic states, including cryptogenic stroke, platypnea-orthodeoxia syndrome, decompression sickness and migraine with auras. Transesophageal echocardiography (TEE) has a major role in the diagnostic evaluation of PFO, as well as in the post-procedural assessment after transcatheter closure. The goals of this article were to synthesize the echocardiographic transesophageal techniques required for accurate PFO diagnosis and careful anatomic assessment of its anatomic variants, to focus TEE indications for device closure as complementary to clinical indications and to assess the role of TEE in the post-procedure follow-up.
Collapse
|
10
|
Savino K, Maiello M, Pelliccia F, Ambrosio G, Palmiero P. Patent foramen ovale and cryptogenic stroke: from studies to clinical practice: Position paper of the Italian Chapter, International Society Cardiovascular Ultrasound. Int J Clin Pract 2016; 70:641-8. [PMID: 27384340 DOI: 10.1111/ijcp.12842] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Over the last two decades the interest on patent foramen ovale (PFO) as a cause of cardioembolism in cryptogenic stroke has tremendously increased, thanks to the availability of better techniques to diagnose cardiac right-to-left shunt by ultrasounds and of percutaneous means of PFO treatment with interventional techniques. Many studies have been published that have attempted to define diagnostic methodology, prognosis, and optimal treatment (pharmacological or percutaneous closure) of PFO patients with cryptogenic stroke. Unfortunately, even today, definitive evidence is still lacking, and clinical management is not consistent among cardiologists. AIMS This review aims to evaluate the role of PFO in cryptogenic stroke, the diagnostic accuracy of transcranial Doppler, contrast transthoracic and transesophageal echocardiography in the diagnosis of left-fright shunt and PFO; and discuss the indications to medical treatment and percutaneous closure of PFO. METHODS All studies published in the literature on PFO and cryptogenic stroke are considered and discussed. RESULTS We define an appropriate diagnostic and clinical management of PFO patients with cryptogenic stroke. CONCLUSION After many years of interest on PFO and many concluded studies, there are still no definitive data. However, we are on good track for an appropriate management of PFO patients and cryptogenic stroke.
Collapse
Affiliation(s)
- K Savino
- Division of Cardiology - S. Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - M Maiello
- ASL Brindisi, District Cardiology Equipe, Brindisi, Italy
| | - F Pelliccia
- Department Heart and Great Vessels "Attilio Reale", University "La Sapienza" Rome, Rome, Italy
| | - G Ambrosio
- Division of Cardiology - S. Maria della Misericordia Hospital, University of Perugia School of Medicine, Perugia, Italy
| | - P Palmiero
- ASL Brindisi, District Cardiology Equipe, Brindisi, Italy
| |
Collapse
|
11
|
Moral S, Ballesteros E, Huguet M, Panaro A, Palet J, Evangelista A. Differential Diagnosis and Clinical Implications of Remnants of the Right Valve of the Sinus Venosus. J Am Soc Echocardiogr 2016; 29:183-94. [DOI: 10.1016/j.echo.2015.11.018] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2015] [Indexed: 11/16/2022]
|
12
|
Affiliation(s)
- Arjun K Ghosh
- Specialty Registrar in Cardiology, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London W12 0HS
| | - Ajay Jain
- Consultant Cardiologist at Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London
| |
Collapse
|
13
|
Lunetta M, Costa F, Gattuta ML, Novo S. Transesophageal Contrast Echocardiography is Not Always the Gold Standard Method in the Identification of a Patent Foramen Ovale: A Clinical Case. J Cardiovasc Echogr 2015; 25:86-89. [PMID: 28465942 PMCID: PMC5353415 DOI: 10.4103/2211-4122.166084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
In the embryo, Eustachian valve is a crescent-shaped membrane extending from the lower margin of the inferior vena cava and the ostium of the coronary sinus into the right atrium toward fossa ovalis and tricuspid valve. At birth, after the functional closure of the foramen ovale, the Eustachian valve loses its function, reducing to an embryo remnant. According to growing evidence, a persistent Eustachian valve is a frequent finding in patients with a patent foramen ovale (PFO). By directing the blood from the inferior cava to the interatrial septum, it may prevent the spontaneous closure of PFO after birth and indirectly predispose to paradoxical embolism. Transesophageal contrast enhanced echocardiography (cTEE) is considered the gold standard to diagnose a PFO in postnatal life, but its accuracy maybe is not so high in the presence of a persistent Eustachian valve. In these cases, color Doppler TEE is more sensitive and simplifies the diagnostic process, reducing the duration of TEE and improving the patient compliance.
Collapse
Affiliation(s)
- Monica Lunetta
- Department of Internal Medicine and Specialty, University Hospital of Palermo, Palermo, Italy
| | - Francesco Costa
- Department of Clinical and Experimental Medicine, Cardiology Unit, University Hospital of Messina, Messina, Italy
| | - Marcello La Gattuta
- Department of Radiology, DIBIMEF, University Hospital "P Giaccone", University of Palermo, Palermo, Italy
| | - Salvatore Novo
- Department of Internal Medicine and Specialty, University Hospital of Palermo, Palermo, Italy
| |
Collapse
|
14
|
Schuchlenz H. Letter by Schuchlenz Regarding Article, “Transesophageal Echocardiography in Cryptogenic Stroke and Patent Foramen Ovale Analysis of Putative High-Risk Features From the Risk of Paradoxical Embolism Database”. Circ Cardiovasc Imaging 2014; 7:572. [DOI: 10.1161/circimaging.113.001530] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Herwig Schuchlenz
- Department für Kardiologie und Intensivmedizin, LKH Graz West, Graz, Austria
| |
Collapse
|
15
|
Fenster BE, Curran-Everett D, Freeman AM, Weinberger HD, Kern Buckner J, Carroll JD. Saline Contrast Echocardiography for the Detection of Patent Foramen Ovale in Hypoxia: A Validation Study Using Intracardiac Echocardiography. Echocardiography 2013; 31:420-7. [DOI: 10.1111/echo.12403] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Affiliation(s)
| | - Douglas Curran-Everett
- Division of Biostatistics and Bioinformatics; National Jewish Health; Denver Colorado
- Division of Biostatistics and Informatics; Colorado School of Public Health; Aurora Colorado
| | | | | | - J. Kern Buckner
- Division of Cardiology; National Jewish Health; Denver Colorado
| | - John D. Carroll
- Division of Cardiology; University of Colorado; Aurora Colorado
| |
Collapse
|
16
|
Kutty S, Sengupta PP, Khandheria BK. Patent Foramen Ovale. J Am Coll Cardiol 2012; 59:1665-71. [DOI: 10.1016/j.jacc.2011.09.085] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2011] [Revised: 09/09/2011] [Accepted: 09/13/2011] [Indexed: 10/28/2022]
|
17
|
Pitfalls in diagnosing PFO: characteristics of false-negative contrast injections during transesophageal echocardiography in patients with patent foramen ovales. J Am Soc Echocardiogr 2010; 23:1136-42. [PMID: 20850947 DOI: 10.1016/j.echo.2010.08.004] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2010] [Indexed: 12/16/2022]
Abstract
BACKGROUND Contrast injections during transesophageal echocardiography for patent foramen ovale (PFO) detection may be false negative. The characteristics of false-negative injections were studied retrospectively. METHODS Contrast transesophageal echocardiography was analyzed for the presence or absence of two characteristics: leftward bulging of the interatrial septum and dense contrast filling of the region of the right atrium adjacent to the interatrial septum. RESULTS Two hundred forty-seven injections were administered to 14 patients with PFOs, and 130 (53%) were false negative. The absence of either characteristic during a single injection resulted in low sensitivity for PFO detection of 7%. When the two characteristics were present at the same time, the sensitivity for PFO detection after a single injection was as high as 95%. CONCLUSIONS The simultaneous presence of both leftward bulging of the interatrial septum and dense contrast filling of the region in the right atrium, adjacent to the interatrial septum, is a prerequisite for PFO detection, and if either characteristic is missing, the injection is inconclusive.
Collapse
|
18
|
Shiina Y, Funabashi N, Teramoto K, Uehara M, Takaoka H, Mikami Y, Takahashi A, Saito M, Daimon M, Lee K, Kawakubo M, Sekine Y, Takahashi M, Yajima R, Tani A, Komuro I. Suitable solutions for reconstituting the ultrasound contrast agent "Levovist" used in contrast echocardiogram: in vitro and in vivo evaluation of the influence of osmotic pressure. Int J Cardiol 2009; 136:335-40. [PMID: 18678422 DOI: 10.1016/j.ijcard.2008.05.043] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2008] [Accepted: 05/10/2008] [Indexed: 10/21/2022]
Abstract
PURPOSE To evaluate the influence of the osmotic pressure of solutions used for reconstituting the ultrasound contrast agent "Levovist" on the degree of video intensity of the enhancement and video intensity decay in contrast echocardiogram, we used 6 solutions with different osmotic pressures in both vitro and in vivo experiments. MATERIALS AND METHODS In the in vitro experiments, Levovist was reconstituted with 6 kinds of solutions with different osmotic pressures (Lactate Ringer's solution, 2.5%, 5%, 7.5%, and 20% glucose and distilled water) and peak video intensities and video intensity decay were measured. In the in vivo experiments, contrast echocardiography was performed in 7 adult volunteers, following the intravenous injections of Levovist, previously reconstituted with one of 2 solutions (5% glucose or distilled water). RESULTS In vitro, at peak time, Levovist reconstituted with either Lactate Ringer's solution, 2.5% glucose, 5% glucose, or distilled water had good peak video intensities. At 30 s after peak time, Levovist reconstituted with Lactate Ringer's solution had greater enhancement and less decay than the other 5 solutions (P<0.001). In vivo, at 180 heart beats after peak time, the video intensity decay with 5% glucose was greater than that with distilled water (150+/-13 dB, 123+/-25 dB, respectively, P<0.05). CONCLUSION In this study, among various (2.5-20%) glucose solutions, the stability of the microbubbles differed, depending on the degree of osmotic pressure of the respective solutions; 5% glucose was the best. However, overall, the most suitable solution for reconstituting Levovist, was Lactate Ringer's solution. These findings could lead to effective strategies for better contrast echocardiography using Levovist by changing the current solution of choice to Lactate Ringer's solution or 5% glucose.
Collapse
Affiliation(s)
- Yumi Shiina
- Department of Cardiovascular Science and Medicine, Chiba University Graduate School of Medicine, Chiba City, Chiba, Japan
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
19
|
Cheng TO. Eustachian valve, patent foramen ovale and paradoxical embolism. Int J Cardiol 2007; 117:138-9. [PMID: 16872700 DOI: 10.1016/j.ijcard.2006.05.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2006] [Accepted: 05/21/2006] [Indexed: 10/24/2022]
|