title: Transforaminal Doppler: an alternative to transtemporal approach for right-to-left cardiac shunt assessment.
abstract: BACKGROUND
  Paradoxical thrombotic embolism via right-to-left shunt is a risk factor for ischemic stroke, especially in younger subjects. Transtemporal Doppler shows a sensibility and specificity in the detection of patent foramen ovale comparable to that of transesophageal echocardiography, but even younger patients may not have a sufficient acoustic temporal bone window (up to 10%).
  
  
  RESULTS
  We thus studied prospectively in 74 patients subsequent to a recent stroke of undetermined origin whether transforaminal (foramen magnum) Doppler is an alternative to transtemporal Doppler in the detection and quantification of right-to-left cardiac shunt. We found a highly significant correlation between the two methods.
  
  
  CONCLUSIONS
  We conclude that transforaminal Doppler may be a complement and alternative to transtemporal Doppler and thus improve its value as a screening method for right-to-left cardiac shunt due to patent foramen ovale.
authors.affiliation: HUG University Hospital and Medical Faculty, University of Geneva, Department of Neurology, 1211 Geneva, Switzerland. fabienne.perren@hcuge.ch
authors.forename: Fabienne
authors.initials: F
authors.lastname: Perren
authors.forename: Elena
authors.initials: E
authors.lastname: Savva
authors.forename: Theodor
authors.initials: T
authors.lastname: Landis
mesh_terms: D006328:Cardiac Catheterization / Q000009:adverse effects; D017548:Echocardiography, Transesophageal; D005260:Female; D054092:Foramen Ovale, Patent / Q000150:complications / Q000000981:diagnostic imaging*; D006346:Heart Septum / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012680:Sensitivity and Specificity