Transcranial Ultrasound Method Outdoes Echocardiography for Finding PFO

Frontline Medical News, 2014 Mar 04, NS Miller

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http://www.practiceupdate.com/news/4429

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Researchers analyzed data from 340 patients with cryptogenic stroke suspected of paradoxical embolism who had had their right-left shunt confirmed with transcranial Doppler saline study (TCDSS). Transesophageal echocardiography (TEE) failed to show a shunt such as patent foramen ovale (PFO) in 15% of the cases. 

“I was surprised by the number,” said Dr. J. David Spence, senior researcher of the study, who presented the findings at the International Stroke Conference, sponsored by the American Heart Association. “I had realized that some of the patients with shunts were missed by TEE, … but I was surprised by how often that happened.”

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Enviado por Dra Ana Feijão.

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Aqui, link de simulador de Doppler transcraniano. Veja como é fácil para quem faz ecocardiograma.

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When 10 microbubbles was used as the embolic cutoff for a positive TCD study, TCD produced a higher specificity compared with when 1 microbubble was used as the cutoff (p = 0.04); there was, however, no significant change in sensitivity (p = 0.29).

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Conclusions  TCD is a reliable, noninvasive test with excellent diagnostic accuracies, making it a proficient test for detecting RLS. TCD can be used as a part of the stroke workup and for patients being considered for PFO closure. If knowledge of the precise anatomy is required, then TEE can be obtained before scheduling a patient for transcatheter PFO closure.

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É sempre desconfortável injetar bolhas de ar em um paciente com shunt D-E.

Mas o estudo de 1,968 patients (mean age 47.8 ± 5.7 years; 51% male) revelou segurança e sensibilidade 

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A técnica do exame transcraniano é tão simples que mesmo clínicos sem treinamento em ultrassom podem executar após um curso básico.

.http://youtu.be/SKietAuhh8A