Can Transthoracic Echocardiography Be Useful Detecting Patent Foramen Ovale In Stroke? The Of Valsalva Maneuver (P4.231)

OBJECTIVE: The aim of our study is to compare the efficacy between transcranial doppler (TCD), TEE and simultaneous TCD-transthoracic echocardiography (TTE) detecting right-to-left shunt. BACKGROUND: Transesophageal echocardiography (TEE) is considered the gold standard to detect patent foramen ovale (PFO), but it has some known limitations. DESIGN/METHODS:A retrospective study was conducted. Patients diagnosed of migraine or ischemic stroke were included. Right-to-left shunts detected by TCD were compared with TEE results. When results from both techniques were different, a simultaneous TCD-TTE study was performed. The shunt size was classified according to the number of microbubbles detected by TCD. RESULTS: 98 patients were included. In 48 cases (49%), right-to-left shunt was diagnosed by TCD. In 26 of these patients, results from TCD and TEE were compared: A concordance of 76.9% was found between both techniques, but in 6 cases the shunt wasn’t detected by TEE. In 4 of these 6 cases, we performed a simultaneous TCD-TTE. All cases were detected by TTE. The Valsalva maneuver diagnosed 6 of 20 cases (30%) with TEE and 3 of 4 cases (75%) with TCD-TTE. CONCLUSIONS: TTE and TCD can be more useful than TEE to detect right-to-left shunt. This outcome may be related with the better effectiveness of the Valsalva maneuver with TTE or TCD than with TEE. The shunt detection by TTE or TEE was not related with its magnitude. Study Supported by: No Disclosure: Dr. Iglesias Mohedano has nothing to disclose. Dr. Diaz Otero has nothing to disclose. Dr. Garcia Pastor has nothing to disclose. Dr. Yotti has nothing to disclose. Dr. Vazquez Alen has nothing to disclose. Dr. Dominguez Rubio has nothing to disclose. Dr. Romero Delgado has nothing to disclose. Dr. Munoz Gonzalez has nothing to disclose. Dr. Sobrino Garcia has nothing to disclose. Dr. Fernandez Bullido has nothing to disclose. Dr. Villanueva Osorio has nothing to disclose. Dr. Gil-Nunez has nothing to disclose.