TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND CONTRAST-TCD IN THE DETECTION OF A PATENT FORAMEN OVALE - EXPERIENCES WITH 111 PATIENTS
TRANSESOPHAGEAL ECHOCARDIOGRAPHY AND CONTRAST-TCD IN THE DETECTION OF A PATENT FORAMEN OVALE - EXPERIENCES WITH 111 PATIENTS
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DOI：
10.1212/wnl.44.9.1603
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发表时间：
1994-09-01
期刊：
影响因子：
9.9
通讯作者：
BERLIT, P
中科院分区：
文献类型：
--
作者：
KLOTZSCH, C;JANSSEN, G;BERLIT, P
卵圆孔未闭（PFO）越来越多地被认为与隐源性卒中有关。采用经食管超声心动图（TEE）和经颅多普勒超声与超声造影剂（contrast-TCD），我们评估了PFO的频率作为矛盾栓塞的基本条件，在111例脑缺血后。50例（45%）TEE患者存在右-左分流。在40例病因不明的卒中患者中，31例PFO是唯一可检测到的与脑缺血相关的发现。以TEE为“金标准”，对比TCD的敏感性为91.3%，特异性为93.8%，总体准确性为92.8%。对比TCD未能检测到右-左，分流在4名患者中，但有4名患者与阴性TEE和阳性对比TCD。我们得出结论，对比TCD是一个高度敏感的方法检测右-左分流。它的优点是成本低，能够检测单一造影剂栓塞，并通过观察脑血流量的减少来控制Valsalva动作。隐源性卒中中PFO的证据应提示寻找亚临床静脉血栓形成作为栓塞源。
Patent foramen ovale (PFO) is increasingly recognized in association with cryptogenic stroke. Using transesophageal echocardiography (TEE) and transcranial Doppler sonography with ultrasonic contrast medium (contrast-TCD), we evaluated the frequency of a PFO as the fundamental condition of paradoxical embolism in 111 patients after cerebral ischemia. There was a right-left shunt in 50 patients (45%) with TEE. In 31 of 40 patients with stroke of unknown etiology, a PFO was the only detectable finding associated with cerebral ischemia. Using TEE as the ''gold standard,'' the sensitivity of contrast-TCD was 91.3%, specificity 93.8%, and the overall accuracy 92.8%. Contrast-TCD failed to detect a right-left, shunt in four patients, but there were four other patients with negative TEE and positive contrast-TCD. We conclude that contrast-TCD is a highly sensitive method for detecting a right-left shunt. Its advantages are low cost, its ability to detect single contrast-medium embolism, and control of the Valsalva maneuver by observing the decrease of cerebral blood flow. Evidence of PFO in cryptogenic stroke should prompt a search for a subclinical venous thrombosis as the embolic source.