Key result
This review outlines current diagnostic procedures (TTE, TOE, and TCD) used to detect and grade a patent foramen ovale, highlighting methods to optimize imaging and known diagnostic pitfalls.
Why the study?
A patent foramen ovale can cause paradoxical embolism and cryptogenic stroke, but few studies have directly compared TTE with TCD for detection, prompting a review of current diagnostic procedures and imaging optimisation.
What are the current diagnostic procedures, pitfalls, and optimization methods for detecting and grading a patent foramen ovale using echocardiography and transcranial Doppler?
What are the current diagnostic procedures, pitfalls, and optimization methods for detecting and grading a patent foramen ovale using echocardiography and transcranial Doppler?
This review summarizes current diagnostic procedures, pitfalls, and optimization techniques for detecting and grading patent foramen ovale using TTE, TOE, and TCD.
PFO diagnostics may aid cryptogenic stroke evaluation; review extends procedural guidance but leaves open outcome validation.
A patent foramen ovale (PFO) is a common remnant of fetal circulation present in up to 25% of the worldwide adult population. Paradoxical embolism occurs when venous blood crosses the PFO into the arterial system, bypassing the pulmonary circulation. This allows for the direct passage of microemboli into cerebral blood vessels, increasing the risk of cryptogenic stroke. This review investigates the current diagnostic procedures used to detect and grade a PFO, including transthoracic echocardiography (TTE), transoesophageal echocardiography (TOE) and transcranial Doppler (TCD). Only a few studies have directly compared the use of TTE with TCD for PFO detection but several have compared TTE and TCD independently against the clinical gold standard TOE. Known pitfalls of TTE and TCD are also discussed, including the difficulty of differentiating between intracardiac shunts and intrapulmonary shunts. This review also discusses methods to optimise imaging, such as performing an adequate Valsalva manoeuvre, the role of abdominal compression and the choice of the injection site for the contrast agent and how these may increase the diagnostic success of detecting a right-to-left shunt when prompted by a clinician.
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Giessen et al. (2020) conducted a review in Patent foramen ovale. Diagnostic procedures (TTE, TOE, TCD) was evaluated. This review outlines current diagnostic procedures (TTE, TOE, and TCD) used to detect and grade a patent foramen ovale, highlighting methods to optimize imaging and known diagnostic pitfalls.
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