Department of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: http://www.twitter.com/AFordyceOtago.
Department of Medicine, University of Otago, Dunedin, New Zealand. Electronic address: http://www.twitter.com/GWhalleyPhD.
Heart Lung Circ. 2022 Nov;31(11):1471-1481. doi: 10.1016/j.hlc.2022.07.017. Epub 2022 Aug 26.
A patent foramen ovale (PFO) is present in 25% of the population. In some patients, especially those without traditional stroke risk factors and with no immediately apparent cause, a cryptogenic stroke may be caused by an embolus passing through the PFO to the systemic circulation. The identification, or indeed exclusion, of a PFO is sought in these patients, most commonly using contrast-enhanced transthoracic or transoesophageal echocardiography. Another method for detecting a PFO is transcranial Doppler, which allows the detection of PFO possibly without the need for an echo laboratory, and with arguably improved sensitivity. This review will focus on transcranial Doppler detection of PFO, with a brief summary of echocardiographic techniques and the use of ultrasound contrast agents, and the role of provocations to increase diagnostic accuracy, specifically the Valsalva manoeuvre. We discuss the phases alongside the direct and indirect signs of an adequate Valsalva manoeuvre.
卵圆孔未闭（PFO）在 25%的人群中存在。在某些患者中，特别是那些没有传统的中风危险因素且没有明显原因的患者，隐源性中风可能是由于栓子通过 PFO 进入体循环引起的。在这些患者中，通常使用增强对比经胸或经食管超声心动图来寻找或排除 PFO。另一种检测 PFO 的方法是经颅多普勒超声，它可以在可能不需要超声心动图实验室的情况下检测 PFO，并且具有更高的敏感性。本综述将重点介绍经颅多普勒超声检测 PFO，简要介绍超声心动图技术和超声造影剂的应用，以及增加诊断准确性的激发试验的作用，特别是瓦尔萨尔瓦动作。我们将讨论直接和间接征象来评估瓦尔萨尔瓦动作是否充分。
