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Detection of Patent foramen Ovale with Contrast Enhanced Transcranial Doppler at Divers

Abstract

Patent foramen ovale (PFO) is a condition present in 25% of the adult population. It is a remnant of fetal foramen ovale which allows blood to pass from the right to the left atrium, bypassing the fetal lungs. In majority adults it does not have any clinical significance, but in some people it may allow shunting of venous blood into the left atrium (right – left – shunt or RLS), circumventing the lung filter, especially during sneezing, cough, lifting heavy equipment. Is such case, PFO may be a route for venous emboli or gas bubbles from veins to the arterial system. It is known as a paradoxical embolism and may be cause of ischaemic stroke or neurologic decompression sickness (DCI), inner-ear DCI and cutis marmorata. Transesophageal echocardiography is considered as a reference standard in detection of intracardial shunts. Its sensitivity and specificity ranges between 94%-100%. However, TEE is an invasive examination with potentially serious side effects. An alternative examination in RLS detection is contrast enhanced Transcranial Doppler (the bubble study or c-TCD). In comparison to TEE, Transcranial Doppler is not invasive, relatively not expensive and save technique. With its high sensitivity and specificity in detection of PFO, 97% and 93% respectively, it may improve detection of RLS and allow to conduct screening examination for PFO in divers.

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Use of Transcranial Doppler in Intensive Care Unit

thresholds for transcranial Doppler indices of cerebral autoregulation in traumatic brain injury. Neurocrit Care. 2011;14:188-93. 10. Bellner J, Romner B, Reinstrup P, Kristiansson K-A, Ryding E, Brandt L. Transcranial Doppler sonography pulsatility index (PI) reflects intracranial pressure (ICP). Surg Neurol. 2004;62:45-51. 11. Moreno JA, E. Mesalles E, Gener J, Tomasa A, Ley A, Roca J, Fernández-Llamazares J. Evaluating the outcome of severe head injury with transcranial Doppler ultrasonography. Neurosurg Focus. 2000

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Retrospection of the effect of hydroxyurea treatment in patients with sickle cell disease

;11(4):354-62. Nichols FT Jones AM Adams RJ. Stroke prevention in sickle cell disease (STOP) study guidelines for transcranial Doppler testing J Neuroimaging 2001 11 4 171 92 [56] Hussain S, Nichols F, Bowman L, Xu H, Neunert C. Implementation of transcranial Doppler ultrasonography screening and primary stroke prevention in urban and rural sickle cell disease populations. Pediatric blood & cancer 2014. Hussain S Nichols F Bowman L Xu H Neunert C. Implementation of transcranial Doppler ultrasonography screening and primary stroke prevention in urban and rural sickle cell disease

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