Right-to-left shunt detection in patent foramen ovale: The value of synchronized contrast transcranial Doppler and contrast transthoracic echocardiography

Abstract

Patent foramen ovale (PFO) is a common congenital heart disorder associated with stroke, decompression sickness and migraine. Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography has important clinical significance and can improve the accuracy of detecting right-left shunts (RLSs) in patients with PFO. In this letter, regarding an original study presented by Yao et al, we present our insights and discuss how to better help clinicians evaluate changes in PFO-related RLS.

Keywords: Contrast transcranial Doppler; Contrast transthoracic echocardiography; Combined multimodal ultrasound; Patent foramen ovale; Right-to-left shunt

Core Tip: Combining synchronized contrast transcranial Doppler with contrast transthoracic echocardiography enhances the accuracy of detecting right-left shunt (RLS) detection in patients with patent foramen ovale (PFO), who exhibit symptoms such as cryptogenic stroke, migraine, and dizziness. Nonetheless, this study has several limitations, such as the lack of reliability of the results and the low resolution of ultrasound technology. In addition, four-dimensional blood flow magnetic resonance imaging (MRI) is a new technology that has emerged in recent years and can be used to comprehensively evaluate cardiac blood flow patterns by quantifying hemodynamic parameters. It may help detect abnormal right atrial blood flow patterns in PFO and provide visualization of right-to-left shunting. Future studies should include a larger sample size with the gold standard and combine ultrasound and MRI to evaluate RLS alterations associated with PFO completely, thereby offering valuable information for precise diagnosis and treatment.