Transcranial Doppler with contrast injection for the detection of patent foramen ovale in stroke patients.
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.
Department of Medicine, Columbia-Presbyterian Medical Center, New York, NY 10032.
M
M
Di Tullio
R L
RL
Sacco
A
A
Massaro
N
N
Venketasubramanian
D
D
Sherman
M
M
Hoffmann
J P
JP
Mohr
S
S
Homma
D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D002561:Cerebrovascular Disorders / Q000000981:diagnostic imaging* / Q000209:etiology; D004452:Echocardiography / Q000379:methods*; D004453:Echoencephalography; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging* / Q000453:epidemiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D014465:Ultrasonics