Materiały źródłowe

• #1 When and how to diagnose patent foramen ovale

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1768819/

  Patent foramen ovale (PFO) is a common finding in the healthy population, with a prevalence of 27% in one necropsy study of 965 normal hearts from patients with no history of cardioembolic events. It is also the most common cardiac finding in young patients ( 55 years of age) with an unexplained cerebrovascular event, presumably caused by paradoxical emboli. The presumed mechanism is the migration of a thrombus (or less commonly air or fat) from the venous system to the left atrium via a PFO, with subsequent systemic embolisation. Determining whether paradoxical embolism has occurred through a PFO ideally requires the presence of the PFO triad, which combines raised right atrial pressure, venous source of thrombosis, and the presence of PFO. The larger size of a PFO and greater number of microbubbles passing through a shunt during echocardiography has also been associated with an increased incidence of cerebrovascular events.

• #2 Patent foramen ovale: diagnostic evaluation and the role of device closure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9595009/

  Although seemingly benign, the presence of a patent foramen ovale (PFO) may play an important role in the pathophysiology of disease, specifically a paradoxical embolism leading to cryptogenic stroke. […] This review guides physicians in the diagnostic and referral process to a multidisciplinary team involved in PFO closure. […] This review focuses on how PFO is diagnosed following a cryptogenic stroke, highlighting the imaging and provocation of a right-to-left shunt through the interatrial septum (IAS; supplementary material S1, Fig S1). […] Despite an association between PFO and cryptogenic stroke, confirming that association can be challenging as at least one-third of those discovered are likely to be incidental findings. […] The benefit from PFO closure is dependent on the probability that the index stroke is attributable to the PFO.

• #3 Patent foramen ovale – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/patent-foramen-ovale/diagnosis-treatment/drc-20353491

  Usually a patent foramen ovale is diagnosed when tests are done for another health concern. If your health care provider thinks you may have a patent foramen ovale (PFO), imaging tests of the heart may be done. […] A test called an echocardiogram is used to diagnose a PFO. The test uses sound waves to create pictures of the beating heart. An echocardiogram shows the structure of the heart. It also shows how blood flows through the heart and heart valves. […] If you have a patent foramen ovale, this type of echocardiogram usually shows blood moving between the upper heart chambers. […] During a standard echocardiogram, a sterile salt solution containing tiny bubbles is given by IV. The bubbles travel to the right side of the heart. They can be seen on an echocardiogram. […] A patent foramen ovale may be difficult to confirm on a standard echocardiogram. Your provider may recommend this test to get a closer look at the heart. […] It’s considered the most accurate way to diagnose a patent foramen ovale.

• #4 Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-quantification-patent-foramen-ovale–articulo-S188558571000071X

  Patent foramen ovale (PFO) is the most common cause of cryptogenic stroke in patients younger than 55. Transesophageal echocardiography (TEE) has been accepted as the reference diagnostic technique. The purpose of this study was to compare the accuracy of transthoracic echocardiography (TTE), TEE and transcranial Doppler (TCD) in the diagnosis and quantification of patent foramen ovale. […] In 93 patients diagnosed with PFO, the shunt was visualized at baseline by TCD in 69% of cases, by TTE in 74% and by TEE in 58%. TTE enables adequate diagnosis and quantification of PFO. TEE is less sensitive and tends to underestimate the severity of the shunt. […] The aim of the present study was to compare the results obtained by the simultaneous performance of TEE with TCD and of TTE with TCD in the diagnosis and quantification of shunt due to PFO and to define the most suitable diagnostic strategy for its assessment in clinical practice.

• #5 Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-quantification-patent-foramen-ovale–articulo-S188558571000071X

  This study assessed a large series of patients to rule out the presence of right-to-left shunt, and demonstrated that TTE is superior to TEE in the diagnosis of PFO. TEE gave a false negative in more than 10% of the patients and tended to underestimate the severity of right-to-left shunt. […] TTE with harmonic imaging and the administration of agitated physiological saline solution enables adequate assessment and quantification of right-to-left shunt due to PFO. TEE with moderate sedation tends to give false negatives and underestimates the severity of the shunt.

• #6 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  The gold standard for the identification and diagnosis of a PFO is a transesophageal echocardiogram (TEE). […] The American Academy of Neurology recommends the use of a contrast-enhanced TEE for the detection of a PFO and inter-atrial shunting for the potential cause of stroke. […] The sensitivity for PFO detection with a TTE bubble study is 50 %. […] Several anatomical features accompanying PFO have been associated with recurrent stroke. […] The recurrence rate of ischemic stroke in patients with PFO and medically-treated cryptogenic stroke ranges between 0.6 % and 1.5 % per year. […] The updated 2014 American Heart Association/American Stroke Association (AHA/ASA) guidelines have a Class I, Level of Evidence (LOE) B indication for antiplatelet therapy in ischemic stroke/TIA patients with a PFO as well as a Class I, LOE A for anticoagulation in patients with an ischemic stroke/ TIA with a PFO and an established PFO.

• #7 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  Multiple randomized-controlled clinical trials (RCTs) have transformed the diagnostic and therapeutic management for cryptogenic stroke patients diagnosed with PFO. […] In this review, we discuss the factors associated with PFO that increase its causal relationship with cryptogenic ischemic stroke, various diagnostic modalities available for PFO detection (transcranial Doppler TCD vs. transthoracic or transesophageal echocardiography TEE) and compare their technical advantages and disadvantages and provide updated diagnostic and treatment management recommendations in cryptogenic stroke patients diagnosed with PFO. […] The evaluation of PFO relies on a detailed assessment with the use of various diagnostic modalities. […] TTE is the most widely and commonly used ultrasound modality to evaluate interatrial septum.

• #8 Patent Foramen Ovale (PFO): Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/17326-patent-foramen-ovale-pfo

  Patent foramen ovale (PFO) is a small hole between the upper right and left chambers (atria) of your heart. PFO often has no symptoms. Many people dont need treatment unless theyre at risk of stroke or blood clots. Treatments include medications and closure of the hole with a catheter or surgery. […] Most of the time, people with PFO dont have symptoms and wont need treatment. But some uncommon problems related to the presence of PFO include stroke and mini-stroke. […] Your healthcare provider will first ask about your symptoms and do a physical exam. If your provider suspects PFO, they may recommend the following tests: […] Your provider may also suggest a bubble test, along with an echo or TCD ultrasound. During a bubble test, they inject saltwater solution into your vein. You may have PFO if your lungs dont filter out the bubbles and they travel through the hole to your left side of your heart.

• #9 Patent Foramen Ovale | Diagnosis | UK Healthcare

  https://ukhealthcare.uky.edu/gill-heart-vascular-institute/conditions/structural-heart-disease/patent-foramen-ovale/diagnosis

  Because PFO does not typically cause symptoms other than migraine, stroke or TIA, doctors usually find it while investigating another health concern. […] If you go to the hospital with stroke-like symptoms, your doctor may perform an echocardiogram to evaluate for a PFO. This type of test relies on ultrasound technology, or sound waves, to capture an image of your hearts structure. During the echocardiogram, your doctor will study your heart carefully to identify anything that looks abnormal. Your doctor may also administer a saline solution into your body. If you have a PFO, your doctor will see small air bubbles traveling from the right side of your heart to the left.

• #10 Patent Foramen Ovale (PFO): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/patent-foramen-ovale-pfo/treatment

  How is Patent Foramen Ovale (PFO) Diagnosed? Diagnosis A PFO is usually discovered while testing for another health issue. Your doctor may order one of the following specialized tests to diagnose PFO: Echocardiogram (transthoracic echocardiogram) – An echocardiogram is an ultrasound test that uses sound waves to look at the structures and function of the heart. The images are obtained from the chest wall. This a common test used to determine a PFO diagnosis in children and adults. […] Transesophageal echocardiogram – Similar to a traditional echocardiogram, this test is done using a long probe with a small transducer (microphone-like device) attached to the end. The probe is placed into the mouth and guided down the esophagus, which sits directly behind the heart. Currently, this is the most accurate way to diagnose PFO.

• #11 Patent foramen ovale | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/patent-foramen-ovale?lang=us

  Patent foramen ovale can be an etiological factor in acute ischemic stroke (cryptogenic stroke), consider PFO in younger populations without conventional historical risk factors. […] The ultimate diagnosis of patent foramen ovale is at autopsy by testing for probe patency. One study found that 34% of adults had PFO by this measure. […] Transthoracic echocardiography may suggest the presence of a patent foramen ovale by demonstrating right-to-left shunting not explained by a structural anomaly (e.g. atrial septal defect). […] Transesophageal echocardiography is superior in its ability to diagnose the presence of a PFO and fully delineate atrial septal anatomy and the presence of associated defects. […] A patent foramen ovale can be differentiated from an atrial septal defect because a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen. […] Closure devices, both surgically open and percutaneous, have been developed and are implemented in some centers for PFO.

• #12 Patent Foramen Ovale Workup: Approach Considerations, Imaging Studies

  https://emedicine.medscape.com/article/156863-workup

  No specific laboratory tests are necessary to diagnose patent foramen ovale (PFO), and no specific electrocardiographic findings are noted in affected patients. […] Patent foramen ovale can be detected by various diagnostic cardiac ultrasound studies, including tranthoracic echocardiography (TTE), transesophageal echocardiography (TEE), transmitral doppler (TMD), transcranial doppler (TCD), and intracardiac echocardiography (ICE). […] Color flow Doppler imaging detects some PFO. PFO appears as a small „flame” of color signal in the middle region of the atrial septum. […] Contrast echocardiography appears to improve the diagnostic accuracy of TEE. […] A two-dimensional (2D) TEE with contrast provides superior visualization of the atrial septum and therefore is preferred to transthoracic contrast echocardiography for detecting PFO.

• #13 When and how to diagnose patent foramen ovale

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1768819/

  Although PFO is becoming increasingly recognised as a cause for cryptogenic cerebrovascular events, there are other situations in which documenting a right to left shunt is important. The presence of a large PFO has been associated with severe unexplained decompression sickness caused by paradoxical gas embolism. Transoesophageal echocardiography (TOE) is superior to transthoracic echocardiography (TTE) for the diagnosis of a PFO and delineation of its morphologic details. Hence, TOE is regarded as the imaging procedure of choice in adult patients with suspected paradoxical embolism. For the detection of right-to-left shunting across a PFO, agitated saline contrast medium is typically injected into a peripheral vein during the strain phase of the Valsalva manoeuvre and the atrial septum is imaged during the release phase of this manoeuvre.

• #14 Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-quantification-patent-foramen-ovale–articulo-S188558571000071X

  This study assessed a large series of patients to rule out the presence of right-to-left shunt, and demonstrated that TTE is superior to TEE in the diagnosis of PFO. TEE gave a false negative in more than 10% of the patients and tended to underestimate the severity of right-to-left shunt. […] TTE with harmonic imaging and the administration of agitated physiological saline solution enables adequate assessment and quantification of right-to-left shunt due to PFO. TEE with moderate sedation tends to give false negatives and underestimates the severity of the shunt.

• #15 Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography – Revista Española de Cardiología

  https://www.revespcardiol.org/es-diagnosis-quantification-patent-foramen-ovale–articulo-S188558571000071X

  This study assessed a large series of patients to rule out the presence of right-to-left shunt, and demonstrated that TTE is superior to TEE in the diagnosis of PFO. TEE gave a false negative in more than 10% of the patients and tended to underestimate the severity of right-to-left shunt. […] TTE with harmonic imaging and the administration of agitated physiological saline solution enables adequate assessment and quantification of right-to-left shunt due to PFO. TEE with moderate sedation tends to give false negatives and underestimates the severity of the shunt.

• #16 Diagnosis | SCAI – Seconds Count

  https://www.secondscount.org/condition/patent-foramen-ovale-pfo/diagnosis

  Because many people who have a PFO have no symptoms, its usually not diagnosed unless a doctor is conducting tests for a different problem, such as a previous stroke or atrial fibrillation (Afib). In fact, a PFO can be diagnosed only through a specific type of medical test known as an echocardiogram, a noninvasive test that uses sound to create a moving picture of the heart. This test is also known as an echo, Doppler, bubble test or bubble study, or heart ultrasound. […] A TTE takes images within the body from the skins surface without devices entering the body. This is the most common type of echocardiogram performed, but it may be insufficient to diagnose PFO. If treatment (closure) of the PFO is being planned, other types of echocardiography are often needed, such as TEE and ICE. […] A TEE takes images from within the esophagus (food pipe). It can provide more detailed images than traditional echocardiography, but its a more invasive test. […] ICE involves taking images by introducing a catheter into the femoral vein at the groin and delivering the tip of the catheter into the right atrium of the heart. ICE can also provide more detailed images than traditional echocardiography, but its a more invasive test.

• #17 Patent Foramen Ovale (PFO): Diagnosis & Treatment | NewYork-Presbyterian

  https://www.nyp.org/heart/congenital-heart-disease/patent-foramen-ovale-pfo/treatment

  Transcranial Doppler examination – This is another ultrasound test in which the blood flow in the artery under the temple is evaluated. When salt water is injected into the patient’s IV (bubble test), if no bubbles cross the heart wall, the sound of the ultrasound signal does not change. If there is a PFO and salt water crosses to the left side of the heart, it is then pumped to the body, including the head, and can be detected by the ultrasound signal. This is the most sensitive test for finding the right-to-left flow associated with PFO.

• #18 European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism | EuroIntervention

  https://eurointervention.pcronline.com/article/european-position-paper-on-the-management-of-patients-with-patent-foramen-ovale-general-approach-and-left-circulation-thromboembolism

  The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions. […] The diagnosis of PFO is required only for deciding on a treatment. Several techniques can be used to diagnose PFO. […] High-quality comparative studies are still needed to express a conclusive position on the best diagnostic strategies. […] Contrast transoesophageal echocardiography (c-TOE) provides unparalleled visualisation of the interatrial septum and other relevant structures and can show the shunt itself. […] In our updated meta-analysis of 29 studies comparing contrast-enhanced transcranial Doppler (c-TCD) with c-TOE across 2,751 patients, c-TCD had a sensitivity of 94% and a specificity of 92%. […] At present, grounded on the accrued low-quality evidence, no technique can be considered a gold standard and, in most cases, a precise diagnosis of PFO needs the combined use of different techniques, prescribed according to their different characteristics.

• #19 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  Although TTE remains as the preferred initial diagnostic modality, the poor image quality does not permit a detailed cardiac evaluation. […] TCD is an established, cost-effective, and a valid imaging modality for PFO detection. […] TEE remains as the gold standard diagnostic modality for detection of PFO. […] In comparison to routine TTE, both 2D and 3D TEE offers significant anatomic details and should be performed in all adult patients being evaluated for PFO closure. […] TCD has been shown to have a better RLS detection rate in comparison to TEE. […] Accordingly, various practice standards have recommended for TCD as having an equal or superior sensitivity for RLS detection in comparison to TTE or TEE. […] The diagnostic workup in a patient with cryptogenic stroke remains of paramount importance and requires a thorough initial diagnostic workup.

• #20 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  Although TTE remains as the preferred initial diagnostic modality, the poor image quality does not permit a detailed cardiac evaluation. […] TCD is an established, cost-effective, and a valid imaging modality for PFO detection. […] TEE remains as the gold standard diagnostic modality for detection of PFO. […] In comparison to routine TTE, both 2D and 3D TEE offers significant anatomic details and should be performed in all adult patients being evaluated for PFO closure. […] TCD has been shown to have a better RLS detection rate in comparison to TEE. […] Accordingly, various practice standards have recommended for TCD as having an equal or superior sensitivity for RLS detection in comparison to TTE or TEE. […] The diagnostic workup in a patient with cryptogenic stroke remains of paramount importance and requires a thorough initial diagnostic workup.

• #21

  https://journal.hsforum.com/index.php/HSF/article/view/5049

  Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising, noninvasive test for detection of PFO. […] For the diagnosis of PFO, CCT had a mean sensitivity and specificity of 0.70 [95% CI:0.58, 0.79] and 0.97 [95% CI: 0.95, 0.99]. The SROC analysis showed an area under the curve of 0.97. […] CCT shows good diagnostic accuracy in detecting PFO with relatively high sensitivity and specificity. CCT could be considered a noninvasive alternative to transesophageal echocardiography for detecting PFO.

• #22

  https://link.springer.com/article/10.1007/s10554-020-02123-w

  Accurate diagnosis of patent foramen ovale (PFO) and grading of right-to-left shunt severity by the standard method of transthoracic or transesophageal echocardiography (TEE) with bubble injection is often challenging. […] We proposed the novel Maximum Intensity T-Projection (MIP) Imaging method as a complementary or alternative approach for simplified diagnosis and grading of PFO. […] Diagnosis and quantification of PFO by MIP Images were compared to those obtained by standard echocardiographic methods, using the same echocardiography video loops. […] There was good concordance between the conventional echo method and MIP Imaging in the diagnosis and quantification of PFOs. […] MIP Imaging for diagnosis and quantification of PFOs was much less time consuming than the classical method and at least as accurate as the classical method. […] Thus MIP Imaging may be used initially as an adjunct method for PFO diagnosis and quantification and may eventually replace the classical method.

• #23

  https://journal.hsforum.com/index.php/HSF/article/view/5049

  Patent foramen ovale (PFO) has been regarded as a potential source of cryptogenic stroke, which was conventionally detected by transesophageal echocardiography. Cardiac computed tomography (CCT) is a promising, noninvasive test for detection of PFO. […] For the diagnosis of PFO, CCT had a mean sensitivity and specificity of 0.70 [95% CI:0.58, 0.79] and 0.97 [95% CI: 0.95, 0.99]. The SROC analysis showed an area under the curve of 0.97. […] CCT shows good diagnostic accuracy in detecting PFO with relatively high sensitivity and specificity. CCT could be considered a noninvasive alternative to transesophageal echocardiography for detecting PFO.

• #24

  https://link.springer.com/article/10.1007/s10554-020-02123-w

  Accurate diagnosis of patent foramen ovale (PFO) and grading of right-to-left shunt severity by the standard method of transthoracic or transesophageal echocardiography (TEE) with bubble injection is often challenging. […] We proposed the novel Maximum Intensity T-Projection (MIP) Imaging method as a complementary or alternative approach for simplified diagnosis and grading of PFO. […] Diagnosis and quantification of PFO by MIP Images were compared to those obtained by standard echocardiographic methods, using the same echocardiography video loops. […] There was good concordance between the conventional echo method and MIP Imaging in the diagnosis and quantification of PFOs. […] MIP Imaging for diagnosis and quantification of PFOs was much less time consuming than the classical method and at least as accurate as the classical method. […] Thus MIP Imaging may be used initially as an adjunct method for PFO diagnosis and quantification and may eventually replace the classical method.

• #25 Patent Foramen Ovale

  https://mydoctor.kaiserpermanente.org/mas/structured-content/Condition_Patent_Foramen_Ovale_-_CV_Surgery.xml?co=/regions/mas

  Chest X-ray […] This produces a photographic image of the heart and lungs. […] Cardiac catheterization with angiography […] This test produces clear images of the heart and blood flow. We guide a catheter (tube) through a blood vessel in your groin or arm. When it reaches the heart, it releases a contrast dye that allows for detailed X-ray imaging of the heart. […] Cardiac magnetic resonance imaging (MRI) […] This test produces 3-dimensional imaging of the heart so that we can see how blood flows through your heart. […] […] […] PFO is usually found during imaging tests to: […] – Investigate other heart conditions. […] – Determine the cause of a stroke or migraine. […] If you have a stroke with an unknown cause, called a cryptogenic stroke, we may test you for PFO. […] These imaging tests are used to assess heart conditions and strokes.

• #26 When and how to diagnose patent foramen ovale

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1768819/

  Patent foramen ovale (PFO) is a common finding in the healthy population, with a prevalence of 27% in one necropsy study of 965 normal hearts from patients with no history of cardioembolic events. It is also the most common cardiac finding in young patients ( 55 years of age) with an unexplained cerebrovascular event, presumably caused by paradoxical emboli. The presumed mechanism is the migration of a thrombus (or less commonly air or fat) from the venous system to the left atrium via a PFO, with subsequent systemic embolisation. Determining whether paradoxical embolism has occurred through a PFO ideally requires the presence of the PFO triad, which combines raised right atrial pressure, venous source of thrombosis, and the presence of PFO. The larger size of a PFO and greater number of microbubbles passing through a shunt during echocardiography has also been associated with an increased incidence of cerebrovascular events.

• #27 When and how to diagnose patent foramen ovale

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1768819/

  Although TOE is considered to be the gold standard technique for the diagnosis of right-to-left shunts, the use of sedation makes the performance of the Valsalva manoeuvre more difficult. There is also a need for standardisation of PFO identification and quantification, which at present does not exist. In the French PFO-ASA study, a PFO was defined to be present if at least three contrast bubbles appeared in the left atrium. The degree of shunting was defined to be small if 39 contrast bubbles appeared, it was moderate if 1030 contrast bubbles appeared, and large if more than 30 contrast bubbles appeared in the left atrium. Transcranial Doppler is an alternative method for detecting a PFO and is considered by some to be superior to the use of two dimensional echocardiographic imaging of the atrial septum after intravenous injection of saline contrast medium.

• #28 Diagnosis and Quantification of Patent Foramen Ovale. Which Is the Reference Technique? Simultaneous Study With Transcranial Doppler, Transthoracic and Transesophageal Echocardiography – Revista Española de Cardiología (English Edition)

  https://www.revespcardiol.org/en-diagnosis-quantification-patent-foramen-ovale–articulo-S188558571000071X

  Patent foramen ovale (PFO) is the most common cause of cryptogenic stroke in patients younger than 55. Transesophageal echocardiography (TEE) has been accepted as the reference diagnostic technique. The purpose of this study was to compare the accuracy of transthoracic echocardiography (TTE), TEE and transcranial Doppler (TCD) in the diagnosis and quantification of patent foramen ovale. […] In 93 patients diagnosed with PFO, the shunt was visualized at baseline by TCD in 69% of cases, by TTE in 74% and by TEE in 58%. TTE enables adequate diagnosis and quantification of PFO. TEE is less sensitive and tends to underestimate the severity of the shunt. […] The aim of the present study was to compare the results obtained by the simultaneous performance of TEE with TCD and of TTE with TCD in the diagnosis and quantification of shunt due to PFO and to define the most suitable diagnostic strategy for its assessment in clinical practice.

• #29 Patent foramen ovale | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/patent-foramen-ovale?lang=us

  Patent foramen ovale can be an etiological factor in acute ischemic stroke (cryptogenic stroke), consider PFO in younger populations without conventional historical risk factors. […] The ultimate diagnosis of patent foramen ovale is at autopsy by testing for probe patency. One study found that 34% of adults had PFO by this measure. […] Transthoracic echocardiography may suggest the presence of a patent foramen ovale by demonstrating right-to-left shunting not explained by a structural anomaly (e.g. atrial septal defect). […] Transesophageal echocardiography is superior in its ability to diagnose the presence of a PFO and fully delineate atrial septal anatomy and the presence of associated defects. […] A patent foramen ovale can be differentiated from an atrial septal defect because a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen. […] Closure devices, both surgically open and percutaneous, have been developed and are implemented in some centers for PFO.

• #30 Patent Foramen Ovale Differential Diagnoses

  https://emedicine.medscape.com/article/156863-differential

  Other considerations in a patient with suspected patent foramen ovale (PFO) include the following: […] Hypoxemia increases in PFO due to transient elevation of right atrial pressure with an increase in right-to-left shunt resulting in systemic arterial desaturation. […] In off-pump coronary artery bypass surgery, PFO increases the risk of postoperative atrial fibrillation and hypoxemia. […] PFO is often associated with other cardiac anomalies, such as the following: […] In a study by Schneider, 1436 consecutive patients were referred for TEE. A Chiari network was found in 29 subjects (2%), 24 (83%) had PFO, and 7 (24%) had an atrial septal aneurysm. […] In a study of 103 patients by Khositseth who were referred for transcatheter closure for a paradoxical embolism, PFO was present in 81 subjects, ASD in 12 subjects, and both PFO and ASD in 10 subjects. […] In a study by Attenhofer of 106 patients, 79% had either persistent or previously closed PFO or atrial septal defect.

• #31 Patent foramen ovale | Radiology Reference Article | Radiopaedia.org

  https://radiopaedia.org/articles/patent-foramen-ovale?lang=us

  Patent foramen ovale can be an etiological factor in acute ischemic stroke (cryptogenic stroke), consider PFO in younger populations without conventional historical risk factors. […] The ultimate diagnosis of patent foramen ovale is at autopsy by testing for probe patency. One study found that 34% of adults had PFO by this measure. […] Transthoracic echocardiography may suggest the presence of a patent foramen ovale by demonstrating right-to-left shunting not explained by a structural anomaly (e.g. atrial septal defect). […] Transesophageal echocardiography is superior in its ability to diagnose the presence of a PFO and fully delineate atrial septal anatomy and the presence of associated defects. […] A patent foramen ovale can be differentiated from an atrial septal defect because a PFO takes a tunneled intraseptal course, or with the presence of a flap valve on the left atrial side of the foramen. […] Closure devices, both surgically open and percutaneous, have been developed and are implemented in some centers for PFO.

• #32 Patent Foramen Ovale Differential Diagnoses

  https://emedicine.medscape.com/article/156863-differential

  Other considerations in a patient with suspected patent foramen ovale (PFO) include the following: […] Hypoxemia increases in PFO due to transient elevation of right atrial pressure with an increase in right-to-left shunt resulting in systemic arterial desaturation. […] In off-pump coronary artery bypass surgery, PFO increases the risk of postoperative atrial fibrillation and hypoxemia. […] PFO is often associated with other cardiac anomalies, such as the following: […] In a study by Schneider, 1436 consecutive patients were referred for TEE. A Chiari network was found in 29 subjects (2%), 24 (83%) had PFO, and 7 (24%) had an atrial septal aneurysm. […] In a study of 103 patients by Khositseth who were referred for transcatheter closure for a paradoxical embolism, PFO was present in 81 subjects, ASD in 12 subjects, and both PFO and ASD in 10 subjects. […] In a study by Attenhofer of 106 patients, 79% had either persistent or previously closed PFO or atrial septal defect.

• #33 PFO Closure: BCIS Position Statement | ICR Journal

  https://www.icrjournal.com/articles/patent-foramen-ovale-closure-british-cardiovascular-intervention-society-position?language_content_entity=en

  A PFO is only a diagnosis of significant value in the presence of a condition that might warrant its closure. Diagnosing a PFO in otherwise healthy individuals can be unhelpful. A PFO should be sought in the following groups: patients aged 60 years with unexplained stroke, transient ischaemic attack (TIA), MI or other systemic embolism; patients aged 60 years with recurrent stroke, TIA, MI or systemic embolism that remains unexplained; divers with some types of decompression illness; and patients with unexplained hypoxic syndromes. […] Diagnosis is usually made with bubble contrast transthoracic echocardiography (BCTTE). […] The term atrial septal aneurysm should be retired as it can cause unnecessary anxiety; it should be replaced by floppy or mobile septum. […] Diagnosis is usually made with bubble contrast transthoracic echocardiography (BCTTE).

• #34 Patent Foramen Ovale Diagnosis | Heart Health | OneWelbeck

  https://onewelbeck.com/conditions/patent-foramen-ovale-pfo/

  A patent foramen ovale (PFO) is a hole that occurs between the right and left atria of the heart. […] A patent foramen ovale (PFO) is a flap that didnt close. […] Our expert cardiologists at OneWelbeck Heart Health use the latest technology to help diagnose the patent foramen ovale (PFO). […] However, it should only be looked for if you have had a stroke, decompression illness, or some other rare conditions. […] Bubble Transthoracic Echocardiogram (TTE) […] Transesophageal echocardiogram (TOE) […] No.

• #35 PFO Closure: BCIS Position Statement | ICR Journal

  https://www.icrjournal.com/articles/patent-foramen-ovale-closure-british-cardiovascular-intervention-society-position?language_content_entity=en

  A PFO is only a diagnosis of significant value in the presence of a condition that might warrant its closure. Diagnosing a PFO in otherwise healthy individuals can be unhelpful. A PFO should be sought in the following groups: patients aged 60 years with unexplained stroke, transient ischaemic attack (TIA), MI or other systemic embolism; patients aged 60 years with recurrent stroke, TIA, MI or systemic embolism that remains unexplained; divers with some types of decompression illness; and patients with unexplained hypoxic syndromes. […] Diagnosis is usually made with bubble contrast transthoracic echocardiography (BCTTE). […] The term atrial septal aneurysm should be retired as it can cause unnecessary anxiety; it should be replaced by floppy or mobile septum. […] Diagnosis is usually made with bubble contrast transthoracic echocardiography (BCTTE).

• #36 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  To assess the causality associated with a detected PFO, a risk of paradoxical embolism (RoPE) score was developed using data from 12 component studies. […] Treatment options available for secondary stroke prevention in patients with cryptogenic ischemic stroke and PFO include antiplatelet therapy (APT), oral anticoagulation (OAC), and percutaneous PFO closure. […] However, 3 RCTs in 2017 and another in 2018 reaffirmed the longstanding debate on the efficacy of PFO closure in comparison to medical therapy alone. […] The data demonstrated a significant reduction in stroke recurrence among those patients that were assigned to PFO closure combined with APT as compared to those assigned to APT alone. […] PFO closure for cryptogenic strokes in a highly selective patient cohort is cost-effective, produces benefit in quality adjusted life years gained and cumulates to potential cost savings over following years.

• #37 Patent foramen ovale: diagnostic evaluation and the role of device closure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9595009/

  Imaging of the brain should focus on the location and pattern of cerebral infarction. […] The clinical diagnosis of ischaemic brain infarction must be supported by magnetic resonance imaging (MRI) and/or computed tomography (CT), remembering to prior exclude other potential causes including cardioembolic episodes, large-vessel atherosclerosis and lacunar (small-artery) ischaemia. […] Ambulatory electrocardiography (ECG) monitoring (usually for minimum of 72 hours or a 2-week patch recording) is required to exclude atrial arrhythmias (specifically AF) and some cardiologists recommend an implantable loop recorder. […] The transthoracic echocardiography (TTE) with bubble contrast (conducted by injecting agitated saline solution into the left cubital vein) is required for the MDT (supplementary material S1, Figs S1, S2 and S3).

• #38 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  To assess the causality associated with a detected PFO, a risk of paradoxical embolism (RoPE) score was developed using data from 12 component studies. […] Treatment options available for secondary stroke prevention in patients with cryptogenic ischemic stroke and PFO include antiplatelet therapy (APT), oral anticoagulation (OAC), and percutaneous PFO closure. […] However, 3 RCTs in 2017 and another in 2018 reaffirmed the longstanding debate on the efficacy of PFO closure in comparison to medical therapy alone. […] The data demonstrated a significant reduction in stroke recurrence among those patients that were assigned to PFO closure combined with APT as compared to those assigned to APT alone. […] PFO closure for cryptogenic strokes in a highly selective patient cohort is cost-effective, produces benefit in quality adjusted life years gained and cumulates to potential cost savings over following years.

• #39 European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism | EuroIntervention

  https://eurointervention.pcronline.com/article/european-position-paper-on-the-management-of-patients-with-patent-foramen-ovale-general-approach-and-left-circulation-thromboembolism

  The management we propose in this paragraph applies to systemic thromboembolism as well as to all PFO-associated syndromes. […] The association between PFO and cryptogenic left circulation thromboembolism has mainly been addressed in studies including cryptogenic stroke and is strongly supported by epidemiological data, clinical observational studies and by RCTs showing that PFO closure reduces stroke recurrence in comparison with medical therapy. […] A PFO is seen in ~25% of the general population and may therefore coexist by chance in a patient with an unexplained left circulation embolism. […] The risk of paradoxical embolism (RoPE) score represents an attempt to assign a causal relationship probability to individual PFOs in the setting of stroke of unknown cause and may be useful in helping to guide management decisions. […] The management of patients with cryptogenic left circulation thromboembolism and PFO has been controversial, giving rise to heterogeneous strategies across different local realms in Europe.

• #40 European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism | EuroIntervention

  https://eurointervention.pcronline.com/article/european-position-paper-on-the-management-of-patients-with-patent-foramen-ovale-general-approach-and-left-circulation-thromboembolism

  The management we propose in this paragraph applies to systemic thromboembolism as well as to all PFO-associated syndromes. […] The association between PFO and cryptogenic left circulation thromboembolism has mainly been addressed in studies including cryptogenic stroke and is strongly supported by epidemiological data, clinical observational studies and by RCTs showing that PFO closure reduces stroke recurrence in comparison with medical therapy. […] A PFO is seen in ~25% of the general population and may therefore coexist by chance in a patient with an unexplained left circulation embolism. […] The risk of paradoxical embolism (RoPE) score represents an attempt to assign a causal relationship probability to individual PFOs in the setting of stroke of unknown cause and may be useful in helping to guide management decisions. […] The management of patients with cryptogenic left circulation thromboembolism and PFO has been controversial, giving rise to heterogeneous strategies across different local realms in Europe.

• #41 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  Despite medical therapy, the stroke recurrence rate in ischemia stroke patients with PFO is estimated at 4.5 % within a 4-year period. […] Observational data, including meta-analysis of observational studies on PFO closure therapy, point to the safety and low stroke recurrence rate compared to medical treatment alone. […] The Closure I trial evaluated the STARFlex PFO closure system against the administration of warfarin, aspirin, or combined aspirin and warfarin. […] The Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) trial compared the AMPLATZER PFO Occluder with four treatment regimens: monotherapy with warfarin, aspirin or clopidogrel, or a combination of aspirin with extended-release dipyridamole. […] The final decision about PFO management is not necessarily predicated by RoPE score results, and each case should be individually considered with input from cardiology and neurology about how best to treat a specific patient. […] Current AHA/ ASA guidelines recommend antiplatelet therapy in all cryptogenic stroke patients with PFO. […] However, longer-term follow-up data and newer trials have shown a significant decrease in the incidence of recurrent ischemic stroke with PFO closure as compared to medical therapy alone.

• #42 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  The gold standard for the identification and diagnosis of a PFO is a transesophageal echocardiogram (TEE). […] The American Academy of Neurology recommends the use of a contrast-enhanced TEE for the detection of a PFO and inter-atrial shunting for the potential cause of stroke. […] The sensitivity for PFO detection with a TTE bubble study is 50 %. […] Several anatomical features accompanying PFO have been associated with recurrent stroke. […] The recurrence rate of ischemic stroke in patients with PFO and medically-treated cryptogenic stroke ranges between 0.6 % and 1.5 % per year. […] The updated 2014 American Heart Association/American Stroke Association (AHA/ASA) guidelines have a Class I, Level of Evidence (LOE) B indication for antiplatelet therapy in ischemic stroke/TIA patients with a PFO as well as a Class I, LOE A for anticoagulation in patients with an ischemic stroke/ TIA with a PFO and an established PFO.

• #43 Atrial Septal Defects and Patent Foramen Ovale: Current Data Update – Cardiac Interventions Today

  https://citoday.com/articles/2022-jan-feb/atrial-septal-defects-and-patent-foramen-ovale-current-data-update

  Given the high prevalence of PFO in the general population, transcatheter PFO closure should be reserved for patients with a high probability of a PFO-related embolic event, whereas medical therapy should be considered if the probability is low. […] The Risk of Paradoxical Embolism (RoPE) score classifies the relationship between CS and PFO, but it still needs external validation and does not include some variables that have been associated with higher recurrence rate (ie, atrial septal aneurysms [ASAs], PFO dimension, coagulation disorders) and a higher risk of CS (ASA, PFO dimension, embryonic residues, shunt severity). […] Other potential causes of an ischemic event should be excluded before proceeding to intervention. […] Identification of AF is extremely important, as it may cause both systemic embolism and recurrences caused by left atrial appendage thrombus rather than paradoxical embolism.

• #44 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  To assess the causality associated with a detected PFO, a risk of paradoxical embolism (RoPE) score was developed using data from 12 component studies. […] Treatment options available for secondary stroke prevention in patients with cryptogenic ischemic stroke and PFO include antiplatelet therapy (APT), oral anticoagulation (OAC), and percutaneous PFO closure. […] However, 3 RCTs in 2017 and another in 2018 reaffirmed the longstanding debate on the efficacy of PFO closure in comparison to medical therapy alone. […] The data demonstrated a significant reduction in stroke recurrence among those patients that were assigned to PFO closure combined with APT as compared to those assigned to APT alone. […] PFO closure for cryptogenic strokes in a highly selective patient cohort is cost-effective, produces benefit in quality adjusted life years gained and cumulates to potential cost savings over following years.

• #45 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  Despite medical therapy, the stroke recurrence rate in ischemia stroke patients with PFO is estimated at 4.5 % within a 4-year period. […] Observational data, including meta-analysis of observational studies on PFO closure therapy, point to the safety and low stroke recurrence rate compared to medical treatment alone. […] The Closure I trial evaluated the STARFlex PFO closure system against the administration of warfarin, aspirin, or combined aspirin and warfarin. […] The Randomized Evaluation of Recurrent Stroke Comparing PFO Closure to Established Current Standard of Care Treatment (RESPECT) trial compared the AMPLATZER PFO Occluder with four treatment regimens: monotherapy with warfarin, aspirin or clopidogrel, or a combination of aspirin with extended-release dipyridamole. […] The final decision about PFO management is not necessarily predicated by RoPE score results, and each case should be individually considered with input from cardiology and neurology about how best to treat a specific patient. […] Current AHA/ ASA guidelines recommend antiplatelet therapy in all cryptogenic stroke patients with PFO. […] However, longer-term follow-up data and newer trials have shown a significant decrease in the incidence of recurrent ischemic stroke with PFO closure as compared to medical therapy alone.

• #46 Patent Foramen Ovale (PFO): History, Diagnosis, and Management

  https://www.imrpress.com/journal/RCM/25/11/10.31083/j.rcm2511422

  Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). […] In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. […] Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. […] While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.

• #47 Patent Foramen Ovale (PFO): History, Diagnosis, and Management

  https://www.imrpress.com/journal/RCM/25/11/10.31083/j.rcm2511422

  Current guidelines recommend closing a patent foramen ovale (PFO) in patients who have experienced a cryptogenic or cardioembolic stroke, have a high-risk PFO, and are aged between 16 and 60 years (class A recommendation, level I evidence). […] In terms of efficacy, in the CLOSE and RESPECT trials, the number needed-to-treat (NNT) to prevent one stroke recurrence in a five-year term was between 20 and 44. […] Interventional PFO closure is relatively straightforward to learn compared to other cardiology procedures; however, it must be performed meticulously to minimize the risk of post-procedural complications. […] While the potential benefits of PFO closure for conditions such as migraines are currently being studied, robust trials are still required. Therefore, deciding to close a PFO for reasons other than stroke should be considered on a case-by-case basis.

• #48 Management of Patent Foramen Ovale | USC Journal

  https://www.uscjournal.com/articles/update-management-patent-foramen-ovale-2017-indication-closure-and-literature-review?language_content_entity=en

  The gold standard for the identification and diagnosis of a PFO is a transesophageal echocardiogram (TEE). […] The American Academy of Neurology recommends the use of a contrast-enhanced TEE for the detection of a PFO and inter-atrial shunting for the potential cause of stroke. […] The sensitivity for PFO detection with a TTE bubble study is 50 %. […] Several anatomical features accompanying PFO have been associated with recurrent stroke. […] The recurrence rate of ischemic stroke in patients with PFO and medically-treated cryptogenic stroke ranges between 0.6 % and 1.5 % per year. […] The updated 2014 American Heart Association/American Stroke Association (AHA/ASA) guidelines have a Class I, Level of Evidence (LOE) B indication for antiplatelet therapy in ischemic stroke/TIA patients with a PFO as well as a Class I, LOE A for anticoagulation in patients with an ischemic stroke/ TIA with a PFO and an established PFO.

• #49 Patent foramen ovale: diagnostic evaluation and the role of device closure

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9595009/

  A TOE may be required after MDT discussion and will provide additional information by assessing the size and location of the PFO tunnel and the interatrial shunt can be further evaluated (Fig 1). […] The NHS England commissioning policy (Box 1) guides physicians in the selection of suitable candidates for device closure with an aim to prevent exposing patients to potential procedural and device-related risks unless there is clear benefit from percutaneous closure. […] While the current NHS commissioning criteria permit device closure of PFO for secondary prevention of cryptogenic stroke, they do not presently consider PFO closure for primary prevention of stroke or for other pathological conditions. […] PFO device closure plus anti-platelet therapy lowers the risk of recurrent cryptogenic stroke compared with antiplatelet therapy alone. […] Further research is needed to evaluate the effectiveness of PFO device closure in patients presenting with DCS, migraine with aura and platypnoea-orthodeoxia syndrome, among others.

• #50 Patent foramen ovale: diagnosis, indications for closure and complications – The British Journal of Cardiology

  https://bjcardio.co.uk/2011/10/patent-foramen-ovale-diagnosis-indications-for-closure-and-complications/

  PFOs have been associated with neurological decompression sickness in divers. […] There is evidence that divers with a PFO who have suffered decompression sickness after a theoretically safe dive profile benefit from its closure. […] Platypnoea-orthodeoxia syndrome (POS) is a rare condition characterised by dyspnoea and arterial desaturation in the upright position that is relieved in the recumbent position. […] Although the mechanism by which shunting is present in the upright position, but disappears in the recumbent position, has not been fully elucidated, there is evidence that closure of the intracardiac shunt relieves symptoms. […] Interest in the role of PFO in migraine first arose when it was shown that the prevalence of PFO was higher in patients who suffered migraine with aura compared with healthy controls.

• #51 When and how to diagnose patent foramen ovale

  https://pmc.ncbi.nlm.nih.gov/articles/PMC1768819/

  PFO became an important clinical condition to rule out in certain settings, particularly in young patients with cryptogenic stroke, although not confined only to this condition. The use of echocardiography, particularly of TOE with saline contrast, has been of paramount importance in the diagnosis of PFO. It is, however, important to understand the anatomy and physiology of the interatrial septum and related flow, as well as the potential limitations related with the use of this technique, in order that the likelihood of error is significantly reduced.

• #52 European position paper on the management of patients with patent foramen ovale. General approach and left circulation thromboembolism | EuroIntervention

  https://eurointervention.pcronline.com/article/european-position-paper-on-the-management-of-patients-with-patent-foramen-ovale-general-approach-and-left-circulation-thromboembolism

  The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions. […] The diagnosis of PFO is required only for deciding on a treatment. Several techniques can be used to diagnose PFO. […] High-quality comparative studies are still needed to express a conclusive position on the best diagnostic strategies. […] Contrast transoesophageal echocardiography (c-TOE) provides unparalleled visualisation of the interatrial septum and other relevant structures and can show the shunt itself. […] In our updated meta-analysis of 29 studies comparing contrast-enhanced transcranial Doppler (c-TCD) with c-TOE across 2,751 patients, c-TCD had a sensitivity of 94% and a specificity of 92%. […] At present, grounded on the accrued low-quality evidence, no technique can be considered a gold standard and, in most cases, a precise diagnosis of PFO needs the combined use of different techniques, prescribed according to their different characteristics.

• #53 Atrial Septal Defects and Patent Foramen Ovale: Current Data Update – Cardiac Interventions Today

  https://citoday.com/articles/2022-jan-feb/atrial-septal-defects-and-patent-foramen-ovale-current-data-update

  Patent foramen ovale (PFO) and atrial septal defects (ASDs) represent the most common and second most common congenital heart abnormalities, with a prevalence of 25% to 30% in the general population and 1.65 per 1,000 live births, respectively. […] The diagnosis of PFO is made using a combination of techniques and is required only to make a treatment decision. […] At present, the precise diagnosis of PFO is based on the use of different diagnostic modalities, as no technique is considered a gold standard. […] Contrast-enhanced transcranial Doppler is a sensitive method to detect right-to-left shunt during the Valsalva maneuver, although the exact location of the shunt is unknown. […] Contrast-enhanced transesophageal echocardiography (TEE) provides direct visualization of the PFO-related shunt and other structures (ie, the interatrial septum).

• #54 [2105.08267] EchoCP: An Echocardiography Dataset in Contrast Transthoracic Echocardiography for Patent Foramen Ovale Diagnosis

  https://arxiv.org/abs/2105.08267

  Patent foramen ovale (PFO) is a potential separation between the septum, primum and septum secundum located in the anterosuperior portion of the atrial septum. […] For PFO diagnosis, contrast transthoracic echocardiography (cTTE) is preferred as being a more robust method compared with others. […] Currently there is no publicly available dataset for this important topic in the community. […] In this paper, we present EchoCP, as the first echocardiography dataset in cTTE targeting PFO diagnosis. […] We further establish an automated baseline method for PFO diagnosis based on the state-of-the-art cardiac chamber segmentation technique, which achieves 0.89 average mean Dice score, but only 0.60/0.67 mean accuracies for PFO diagnosis, leaving large room for improvement.

• #55 Patent Foramen Ovale: Risk Factors and Diagnostic Comparison of Transcranial Doppler versus Echocardiography for Secondary Stroke Prevention

  https://www.j-nn.org/journal/view.php?number=97

  However, patient selection remains crucial as even marginal declines in the treatment effectiveness dramatically reduce the potential cost benefit. […] Accordingly, recent clinical practice recommendations and European practice guidelines have strongly endorsed in favor of PFO closure for carefully selected patients aged 18-65 years with a confirmed diagnosis of cryptogenic stroke, TIA or systemic embolism. […] The diagnostic management in cryptogenic stroke requires a thorough initial workup and multi-team collaboration. […] Detection of PFO and establishing its causality as a source of paradoxical embolism remains crucial.

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