Follow-up of residual shunt after patent foramen ovale closure

• Published in: Acta neurologica Scandinavica Vol. 122; no. 4; pp. 257 - 261
• Main Authors: Orzan, F., Liboni, W., Bonzano, A., Molinari, F., Ribezzo, M., Rebaudengo, N., Grippi, G., Negri, E.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.10.2010; Blackwell
• Subjects: Adult; Biological and medical sciences; Contrast Media; Echocardiography, Transesophageal; Female; Follow-Up Studies; Foramen Ovale, Patent - diagnostic imaging; Foramen Ovale, Patent - surgery; Humans; Ischemic Attack, Transient - diagnostic imaging; Ischemic Attack, Transient - surgery; Male; Medical sciences; Middle Aged; Neurology; patent foramen ovale; Sensitivity and Specificity; Stroke - diagnostic imaging; Stroke - surgery; transcranial doppler; transesophageal echocardiography; Treatment Outcome; Ultrasonography, Doppler, Transcranial - methods; Sonography; Doppler ultrasound study; Nervous system diseases; Echocardiography; Respiratory disease; Persistent fetal circulation; Cardiovascular disease; transcranial doppler; Congenital disease; Pulmonary hypertension; Newborn diseases; patent foramen ovale; Respiratory failure; Heart disease; transesophageal echocardiography; Ostium secundum
• ISSN: 0001-6314; 1600-0404; 1600-0404
• DOI: 10.1111/j.1600-0404.2009.01302.x

Orzan F, Liboni W, Bonzano A, Molinari F, Ribezzo M, Rebaudengo N, Grippi G, Negri E. Follow‐up of residual shunt after patent foramen ovale closure.
Acta Neurol Scand: 2010: 122: 257–261.
© 2009 The Authors Journal compilation © 2009 Blackwell Munksgaard. Objectives –  Transesophageal echocardiography (TEE) is usually recommended in the evaluation of the patent foramen ovale (PFO). Our goal is to confirm the efficacy of contrast‐enhanced transcranial Doppler (ce‐TCD) in detecting residual significant right‐to‐left shunts (RLS) after PFO percutaneous closure. Materials and methods –  Sixty‐eight patients with a previous transient ischemic attack, stroke and a large PFO were investigated for residual RLS after percutaneous closure. Results –  Assuming TEE as the gold standard, the sensitivity and negative predictive value of ce‐TCD was 100%, whereas the specificity was 75.8% and the positive predictive value was 28%. Conclusions –  ce‐TCD appears to be the preferable technique to identify subjects with significant residual shunts after percutaneous closure of a PFO. In follow‐up, if ce‐TCD is negative, no further examination may be necessary; whereas if ce‐TCD shows a residual shunt, it is advisable to perform a TEE investigation.