Background
Patent foramen ovale (PFO) is a potential mechanism for paradoxical embolism in cryptogenic
ischaemic stroke or transient ischaemic attack (TIA). PFO is typically demonstrated
with agitated saline (“bubble study”, BS) during echocardiography. We hypothesised
that the BS is frequently requested in patients that have a readily identifiable cause
of stroke, that any PFO detected is likely incidental, and its detection often does
not alter management.
Methods
This was a retrospective observational study of patients with recent ischaemic stroke/TIA
referred for a BS. Patient demographics, stroke risk factors, vascular/cerebral imaging
results and transoesophageal echocardiogram (TOE) reports were recorded. A “modified”
Risk of Paradoxical Embolism (RoPE) score was calculated. Change in management was
defined as antiplatelet/anticoagulant therapy alteration or referral for PFO closure.
Bubble Study complications were recorded.
Results
Among 715 patients with ischaemic stroke/TIA referred for a BS, 8.7% had atrial fibrillation
and 9.2% had carotid stenosis ≥70%. At least three stroke risk factors were present
in 39.3% and only 47.1% of patients screened had a “modified” RoPE score of >5. A
PFO was detected in 248 patients of whom only 31% (77/248) had a subsequent change
in management. Of BS performed, 1/924 patients (0.1%) suffered a TIA as a complication.
Conclusions
The echocardiographic BS is frequently performed in patients that have a readily identifiable
cause of stroke and whose PFO unlikely relates to the stroke/TIA. Bubble Study findings
resulted in a change in management in the minority. The procedure is safe but the
complication rate warrants informed consent.
Keywords
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Article info
Publication history
Published online: August 01, 2018
Accepted:
July 18,
2018
Received in revised form:
May 8,
2018
Received:
February 12,
2018
Identification
Copyright
© 2018 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.