Using transcranial Doppler TCD in Right to Left Shunt Patent Foramen Ovale PFO Clinical Application

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Using transcranial Doppler (TCD)in Right to Left
Shunt(Patent Foramen Ovale - PFO) Clinical
Application
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Overview

• Researches today show the increase use of
  transcranial Doppler in diagnosis of Right to
  Left Shunt (Patent Foramen Ovale-PFO).
• TCDs main users for PFO diagnosis are
  Cardiologist in cooperation with Neurologists.

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What is PFO?

• Patent Foramen Ovale (PFO), which is a hole
  between right and left atrium of the heart, is a
  recognized cause of Cryptogenic stroke in young
  adults.
• Emboli from the venous system can pass through
  the hole to the arterial system, and reach the
  cerebral circulation.

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Causes of Stroke

• Blockage of artery
• Clogging of arteries within the brain (e.g.
  lacunar stroke)
• Hardening of the arteries leading to the brain
  (e.g. carotid artery occlusion)
• Embolism to the brain from the heart or an artery
  
• Rupture of an artery (i.e. hemorrhage)
• Cerebral hemorrhage (bleeding within the brain
  substance)
• Subarachnoid hemorrhage (bleeding between the
  brain and the inside of the skull).
• Cryptogenic Stroke
• Cerebral ischemic stroke of unknown origin,
  occurring in the absence of potential
  phanerogenic cardiac, pulmonary, vascular or
  neurological sources.

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Use of transcranial Doppler (TCD) in PFO

• TCD is effectively used to diagnose the
  existence of PFO by injecting saline containing
  air bubbles or echo-contrast enhancing agents and
  identifying signal of air bubbles in the Middle
  Cerebral Artery.

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Diagnosis TCD comparing to TEE
(transthoracic echocardiography)

• TCD is a non-invasive method while TEE is
  invasive.
• TEE may miss as many as 17 of positive cases.
• It is more cost effective to perform TCD as a
  routine diagnostic.

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Treatment

• Todays treatment for PFO can be performed
  without the use of open-heart surgery. Many
  patients are admitted to the hospital in the
  morning and return home that afternoon or the
  next day.

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Manufacturers of Treatment Solutions

• The AMPLATZER PFO Occluder is a self-expandable,
  double disc device made from a Nitinol wire mesh.
  The two discs are linked together by a short,
  connecting waist, allowing free motion of each
  disc. http//www.amplatzer.com/medical_professiona
  ls/pfo.html
• Since 1986, NMT Medical, Inc. has worked with
  physicians to pioneer innovative, catheter-based
  technology to provide a minimally invasive
  treatment for a range of cardiac defects, such as
  Patent Foramen Ovale (PFO), atrial septal defects
  (ASD) and ventricular septal defect (VSD).
  http//www.nmtmedical.com/corpinfo/inv_contact.htm
  l
• The CARDIA family of products has been developed
  for the transvenous closures of certain types of
  Congenital Heart Defects. The devices are
  introduced through standard venous sheaths and
  offer a safe and reliable method for the
  percutaneous closure of PFOs (Patent Foramen
  Ovale).http//www.cardiainc.com/