Follow-up of residual shunt after patent foramen ovale closure
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 echocardiogra...
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Published in | Acta neurologica Scandinavica Vol. 122; no. 4; pp. 257 - 261 |
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Main Authors | , , , , , , , |
Format | Journal Article |
Language | English |
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Oxford, UK
Blackwell Publishing Ltd
01.10.2010
Blackwell |
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ISSN | 0001-6314 1600-0404 1600-0404 |
DOI | 10.1111/j.1600-0404.2009.01302.x |
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Abstract | 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. |
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AbstractList | 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. 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. Sixty-eight patients with a previous transient ischemic attack, stroke and a large PFO were investigated for residual RLS after percutaneous closure. 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%. 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. 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.OBJECTIVESTransesophageal 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.Sixty-eight patients with a previous transient ischemic attack, stroke and a large PFO were investigated for residual RLS after percutaneous closure.MATERIALS AND METHODSSixty-eight patients with a previous transient ischemic attack, stroke and a large PFO were investigated for residual RLS after percutaneous closure.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%.RESULTSAssuming 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%.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.CONCLUSIONSce-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. |
Author | Molinari, F. Negri, E. Orzan, F. Liboni, W. Ribezzo, M. Bonzano, A. Grippi, G. Rebaudengo, N. |
Author_xml | – sequence: 1 givenname: F. surname: Orzan fullname: Orzan, F. organization: Department of Internal Medicine - Cardiology, University of Torino – sequence: 2 givenname: W. surname: Liboni fullname: Liboni, W. organization: Department of Neurology, Gradenigo Hospital – sequence: 3 givenname: A. surname: Bonzano fullname: Bonzano, A. organization: Umberto I Mauriziano Hospital – sequence: 4 givenname: F. surname: Molinari fullname: Molinari, F. organization: BioLab, Department of Electronics, Politecnico di Torino – sequence: 5 givenname: M. surname: Ribezzo fullname: Ribezzo, M. organization: Department of Cardiac Surgery, University of Torino, Torino, Italy – sequence: 6 givenname: N. surname: Rebaudengo fullname: Rebaudengo, N. organization: Department of Neurology, Gradenigo Hospital – sequence: 7 givenname: G. surname: Grippi fullname: Grippi, G. organization: Department of Neurology, Gradenigo Hospital – sequence: 8 givenname: E. surname: Negri fullname: Negri, E. organization: Department of Neurology, Gradenigo Hospital |
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Keywords | 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 |
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References | Landzberg MJ, Khairy P. Indications for the closure of patent foramen ovale. Heart 2004;90:219-24. Onorato E, Melzi G, Casilli F et al. Patent foramen ovale with paradoxical embolism: mid-term results of transcatheter closure in 256 patients. J Interv Cardiol 2003;16: 43-50. Schuchlenz HW. Contrast ultrasound techniques in the detection and quantification of patent foramen ovale: myth versus reality. Stroke 2004;35:2755; author reply, 6. Walsh KP, Wilmshurst PT, Morrison WL. Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers. Heart 1999;81:257-61. Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol 1991;18:1223-9. Du ZD, Cao QL, Joseph A et al. Transcatheter closure of patent foramen ovale in patients with paradoxical embolism: intermediate-term risk of recurrent neurological events. Catheter Cardiovasc Interv 2002;55:189-94. Anzola GP, Frisoni GB, Morandi E, Casilli F, Onorato E. Shunt-associated migraine responds favorably to atrial septal repair: a case-control study. Stroke 2006;37:430-4. Serena J, Segura T, Perez-Ayuso MJ, Bassaganyas J, Molins A, Davalos A. The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study. Stroke 1998;29:1322-8. Windecker S, Wahl A, Nedeltchev K et al. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. J Am Coll Cardiol 2004;44:750-8. Mangiafico S, Scandura S, Ussia GP et al. Transesophageal echocardiography and transcranial color Doppler: independent or complementary diagnostic tests for cardiologists in the detection of patent foramen ovale? J Cardiovasc Med 2009;10:143-8. Spencer MP, Moehring MA, Jesurum J, Gray WA, Olsen JV, Reisman M. Power m-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging 2004;14:342-9. Schuchlenz HW, Weihs W, Horner S, Quehenberger F. The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events. Am J Med 2000;109:456-62. Messe SR, Silverman IE, Kizer JR et al. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004;62:1042-50. Webster MW, Chancellor AM, Smith HJ et al. Patent foramen ovale in young stroke patients. Lancet 1988;2:11-2. Martin F, Sanchez PL, Doherty E et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. Circulation 2002;106:1121-6. Zito C, Dattilo G, Oreto G et al. Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke. Echocardiography 2009;26:495-503. Braun MU, Fassbender D, Schoen SP et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002;39:2019-25. Hung J, Landzberg MJ, Jenkins KJ et al. Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol 2000;35:1311-6. Belvis R, Leta RG, Marti-Fabregas J et al. Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts. J Neuroimaging 2006;16:133-8. Kobayashi K, Igushi Y, Kimura K et al. Contrast transcranial Doppler can diagnose large patent foramen ovale. Cerebrovasc Dis 2009;27:230-4. Lechat P, Mas JL, Lascault G et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988;318:1148-52. Sloan MA, Alexandrov AV, Tegeler CH et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004;62:1468-81. Wahl A, Windecker S, Meier B. Evaluation and treatment of abnormalities of the interatrial septum. Catheter Cardiovasc Interv 2004;63:94-103. Anzola GP, Morandi E, Casilli F, Onorato E. Does transcatheter closure of patent foramen ovale really "shut the door?" A prospective study with transcranial Doppler. Stroke 2004;35:2140-4. Spies C, Strasheim R, Timmermanns I, Schraeder R. Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the cardia PFO occluder. Eur Heart J 2006;27:365-71. Droste DW, Kriete JU, Stypmann J et al. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of different procedures and different contrast agents. Stroke 1999;30:1827-32. Schwerzmann M, Windecker S, Wahl A et al. Percutaneous closure of patent foramen ovale: impact of device design on safety and efficacy. Heart 2004;90:186-90. Butera G, Bini MR, Chessa M, Bedogni F, Onofri M, Carminati M. Transcatheter closure of patent foramen ovale in patients with cryptogenic stroke. Ital Heart J 2001;2:115-8. Sacco RL, Adams R, Albers G et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 2006;113:e409-49. Windecker S, Wahl A, Chatterjee T et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation 2000;101:893-8. Wahl A, Meier B, Haxel B et al. Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism. Neurology 2001;57:1330-2. Hong TE, Thaler D, Brorson J, Heitschmidt M, Hijazi ZM. Transcatheter closure of patent foramen ovale associated with paradoxical embolism using the amplatzer PFO occluder: initial and intermediate-term results of the U.S. multicenter clinical trial. Catheter Cardiovasc Interv 2003;60:524-8. Lock JE. Patent foramen ovale is indicted, but the case hasn't gone to trial. Circulation 2000;101:838. Telman G, Yalonetsky S, Kouperberg E et al. Size of PFO and amount of microembolic signals in patients with ischemic stroke or TIA. Eur J Neurol 2008;15:969-72. Schwerzmann M, Windecker S, Wahl A et al. Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale. Catheter Cardiovasc Interv 2004;63:490-5. 2002; 39 2004; 44 2004; 63 1991; 18 1998; 29 2004; 62 2006; 16 2006; 37 2002; 55 2008; 15 2003; 16 2004; 90 1999; 81 2009; 27 2009; 26 2006; 113 1988; 2 2009; 10 2000; 35 2006; 27 2004; 14 2004; 35 2000; 109 2002; 106 1999; 30 2001; 2 2000; 101 2003; 60 2001; 57 1988; 318 |
References_xml | – reference: Walsh KP, Wilmshurst PT, Morrison WL. Transcatheter closure of patent foramen ovale using the Amplatzer septal occluder to prevent recurrence of neurological decompression illness in divers. Heart 1999;81:257-61. – reference: Kobayashi K, Igushi Y, Kimura K et al. Contrast transcranial Doppler can diagnose large patent foramen ovale. Cerebrovasc Dis 2009;27:230-4. – reference: Lock JE. Patent foramen ovale is indicted, but the case hasn't gone to trial. Circulation 2000;101:838. – reference: Braun MU, Fassbender D, Schoen SP et al. Transcatheter closure of patent foramen ovale in patients with cerebral ischemia. J Am Coll Cardiol 2002;39:2019-25. – reference: Windecker S, Wahl A, Chatterjee T et al. Percutaneous closure of patent foramen ovale in patients with paradoxical embolism: long-term risk of recurrent thromboembolic events. Circulation 2000;101:893-8. – reference: Landzberg MJ, Khairy P. Indications for the closure of patent foramen ovale. Heart 2004;90:219-24. – reference: Sacco RL, Adams R, Albers G et al. Guidelines for prevention of stroke in patients with ischemic stroke or transient ischemic attack: a statement for healthcare professionals from the American Heart Association/American Stroke Association Council on Stroke: co-sponsored by the Council on Cardiovascular Radiology and Intervention: the American Academy of Neurology affirms the value of this guideline. Circulation 2006;113:e409-49. – reference: Lechat P, Mas JL, Lascault G et al. Prevalence of patent foramen ovale in patients with stroke. N Engl J Med 1988;318:1148-52. – reference: Onorato E, Melzi G, Casilli F et al. Patent foramen ovale with paradoxical embolism: mid-term results of transcatheter closure in 256 patients. J Interv Cardiol 2003;16: 43-50. – reference: Anzola GP, Morandi E, Casilli F, Onorato E. Does transcatheter closure of patent foramen ovale really "shut the door?" A prospective study with transcranial Doppler. Stroke 2004;35:2140-4. – reference: Pearson AC, Nagelhout D, Castello R, Gomez CR, Labovitz AJ. Atrial septal aneurysm and stroke: a transesophageal echocardiographic study. J Am Coll Cardiol 1991;18:1223-9. – reference: Anzola GP, Frisoni GB, Morandi E, Casilli F, Onorato E. Shunt-associated migraine responds favorably to atrial septal repair: a case-control study. Stroke 2006;37:430-4. – reference: Schuchlenz HW. Contrast ultrasound techniques in the detection and quantification of patent foramen ovale: myth versus reality. Stroke 2004;35:2755; author reply, 6. – reference: Schwerzmann M, Windecker S, Wahl A et al. Implantation of a second closure device in patients with residual shunt after percutaneous closure of patent foramen ovale. Catheter Cardiovasc Interv 2004;63:490-5. – reference: Spies C, Strasheim R, Timmermanns I, Schraeder R. Patent foramen ovale closure in patients with cryptogenic thrombo-embolic events using the cardia PFO occluder. Eur Heart J 2006;27:365-71. – reference: Mangiafico S, Scandura S, Ussia GP et al. Transesophageal echocardiography and transcranial color Doppler: independent or complementary diagnostic tests for cardiologists in the detection of patent foramen ovale? J Cardiovasc Med 2009;10:143-8. – reference: Wahl A, Windecker S, Meier B. Evaluation and treatment of abnormalities of the interatrial septum. Catheter Cardiovasc Interv 2004;63:94-103. – reference: Messe SR, Silverman IE, Kizer JR et al. Practice parameter: recurrent stroke with patent foramen ovale and atrial septal aneurysm: report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2004;62:1042-50. – reference: Belvis R, Leta RG, Marti-Fabregas J et al. Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts. J Neuroimaging 2006;16:133-8. – reference: Windecker S, Wahl A, Nedeltchev K et al. Comparison of medical treatment with percutaneous closure of patent foramen ovale in patients with cryptogenic stroke. J Am Coll Cardiol 2004;44:750-8. – reference: Hong TE, Thaler D, Brorson J, Heitschmidt M, Hijazi ZM. Transcatheter closure of patent foramen ovale associated with paradoxical embolism using the amplatzer PFO occluder: initial and intermediate-term results of the U.S. multicenter clinical trial. Catheter Cardiovasc Interv 2003;60:524-8. – reference: Butera G, Bini MR, Chessa M, Bedogni F, Onofri M, Carminati M. Transcatheter closure of patent foramen ovale in patients with cryptogenic stroke. Ital Heart J 2001;2:115-8. – reference: Serena J, Segura T, Perez-Ayuso MJ, Bassaganyas J, Molins A, Davalos A. The need to quantify right-to-left shunt in acute ischemic stroke: a case-control study. Stroke 1998;29:1322-8. – reference: Sloan MA, Alexandrov AV, Tegeler CH et al. Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology. Neurology 2004;62:1468-81. – reference: Hung J, Landzberg MJ, Jenkins KJ et al. Closure of patent foramen ovale for paradoxical emboli: intermediate-term risk of recurrent neurological events following transcatheter device placement. J Am Coll Cardiol 2000;35:1311-6. – reference: Schwerzmann M, Windecker S, Wahl A et al. Percutaneous closure of patent foramen ovale: impact of device design on safety and efficacy. Heart 2004;90:186-90. – reference: Telman G, Yalonetsky S, Kouperberg E et al. Size of PFO and amount of microembolic signals in patients with ischemic stroke or TIA. Eur J Neurol 2008;15:969-72. – reference: Webster MW, Chancellor AM, Smith HJ et al. Patent foramen ovale in young stroke patients. Lancet 1988;2:11-2. – reference: Schuchlenz HW, Weihs W, Horner S, Quehenberger F. The association between the diameter of a patent foramen ovale and the risk of embolic cerebrovascular events. Am J Med 2000;109:456-62. – reference: Spencer MP, Moehring MA, Jesurum J, Gray WA, Olsen JV, Reisman M. Power m-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure. J Neuroimaging 2004;14:342-9. – reference: Zito C, Dattilo G, Oreto G et al. Patent foramen ovale: comparison among diagnostic strategies in cryptogenic stroke. Echocardiography 2009;26:495-503. – reference: Wahl A, Meier B, Haxel B et al. Prognosis after percutaneous closure of patent foramen ovale for paradoxical embolism. Neurology 2001;57:1330-2. – reference: Droste DW, Kriete JU, Stypmann J et al. Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of different procedures and different contrast agents. Stroke 1999;30:1827-32. – reference: Du ZD, Cao QL, Joseph A et al. Transcatheter closure of patent foramen ovale in patients with paradoxical embolism: intermediate-term risk of recurrent neurological events. Catheter Cardiovasc Interv 2002;55:189-94. – reference: Martin F, Sanchez PL, Doherty E et al. Percutaneous transcatheter closure of patent foramen ovale in patients with paradoxical embolism. 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Snippet | 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... Transesophageal echocardiography (TEE) is usually recommended in the evaluation of the patent foramen ovale (PFO). Our goal is to confirm the efficacy of... |
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SubjectTerms | 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 |
Title | Follow-up of residual shunt after patent foramen ovale closure |
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