title: Comparison of transthoracic echocardiography using second harmonic imaging, transcranial Doppler and transesophageal echocardiography for the detection of patent foramen ovale in stroke patients.
abstract: OBJECTIVE
  The comparison of three imaging methods to determine which is the most accurate and reliable for the detection of right-to-left shunt.
  
  
  RESULTS
  One hundred and seven patients who were hospitalized for stroke underwent: a transthoracic echocardiography (TTE) using second harmonic, a transcranial Doppler (TCD) and a transesophageal echocardiography (TEE) from August 2003 to April 2004. All studies were recorded on a videotape and were studied by a physician blinded to the study. With TTE and TEE, we found 44 (41%) patent foramen ovales. All contrast tests were positive with TCD for these 44 patients. For two patients, the contrast test was positive only with TTE and TCD. We found four false negative contrast tests with TTE. Among the 63 patients who had a negative contrast test with TEE and TTE, the results were the same with TCD for 59 of them; we were not able to determine a cause for the four positive tests.
  
  
  CONCLUSIONS
  This study confirms that transesophageal echocardiography has limitations in the diagnosis of patent foramen ovale. In this study, the negative predictive value of transcranial Doppler was excellent. Therefore, this examination is able to exclude a patent foramen ovale with a high level of confidence.
authors.affiliation: Department of Medicine and Cardiology, Hospital Clermont Ferrand, Rue Montalembert, 63000 Clermont Ferrand, France. gacsouteyrand@sympatico.ca
authors.forename: Geraud
authors.initials: G
authors.lastname: Souteyrand
authors.forename: Pascal
authors.initials: P
authors.lastname: Motreff
authors.forename: Jean-René
authors.initials: JR
authors.lastname: Lusson
authors.forename: Raphaël
authors.initials: R
authors.lastname: Rodriguez
authors.forename: Etienne
authors.initials: E
authors.lastname: Geoffroy
authors.forename: Claire
authors.initials: C
authors.lastname: Dauphin
authors.forename: Jean-Yves
authors.initials: JY
authors.lastname: Boire
authors.forename: Dominique
authors.initials: D
authors.lastname: Lamaison
authors.forename: Jean
authors.initials: J
authors.lastname: Cassagnes
mesh_terms: D000328:Adult; D000368:Aged; D002536:Cerebral Arteries / Q000000981:diagnostic imaging*; D003287:Contrast Media; D004452:Echocardiography; D017548:Echocardiography, Transesophageal; D005260:Female; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D018709:Statistics, Nonparametric; D020521:Stroke / Q000209:etiology; D017585:Ultrasonography, Doppler, Transcranial; D014743:Videotape Recording
chemical_list: D003287:Contrast Media