Trans-cranial Doppler (TCD) is superior to trans-oesophageal Echo (TOE/TEE) for shunt detection in PFO.

Here's an interesting interview with Dr David Spence (Canada) at the recent International Stoke Conference, 2014. He confirms that trans-cranial Doppler (TCD) with contrast is superior to that of trans-thoracic (TTE) and trans-oesophageal (TOE/TEE ) echocardiography with contrast for the detection of intra-cardiac right to left shunt. This supports our own experience and justifies our decision to use TCD with contrast as the primary screening tool for PFO/ASD since 2009.

The investigators found that in 15% of patients that had a cryptogenic stroke and positive trans-cranial study, the PFO was missed on the trans-oesophageal echo. Furthermore, 20% of those PFO's that were missed were found to be significant shunts. Dr Spence goes on to conclude that the TCD is more sensitive than the traditional 'Gold Standard' tests and the grading system is more predictive of events than any other anatomic marker such as atrial septal aneurysm.

Migraine with Aura and PFO research presented to Europe’s largest and most prestigious Interventional Cardiology Conference. – Paris, France - May 2014

Authors Dr Ross Sharpe and Mr Daniel Traves have returned from their successful trip to Euro PCR 2014 in Paris, France to present their important preliminary research findings. The Internationally recognised Conference attracted 12,257 participants from around the world. Dr Sharpe was invited to co-chair the session on structural heart disease hosted by Dr Carlos Ruiz from New York.

The abstract was titled:

Dr Carlos Ruiz & Dr Ross Sharpe - EURO PCR 2014

‘Severe migraine with aura and high grade contrast transcranial Doppler shunt predicts symptom relief from transcatheter patent foramen ovale (PFO) closure.’

In the patient series of 71 patients suffering severe migraine with aura, our success rate for complete cure was 83%. A further 14% of patients had >50% symptom relief after successful PFO closure.

Dr Sharpe states “This gives an effective response rate of 97% for this patient population. Other published papers have reported cure rates from 50-75%, so we are very excited about our results. Future research is focussing on other cardiovascular conditions which are associated with PFO.”

“The key to our success is the use of Contrast Transcranial Doppler imaging as it provides us real time physiological information about the PFO, and can predict with high sensitivity those who will benefit for PFO closure. We have been using this screening tool in our practice since 2009.” – Dr Ross Sharpe

Patent Foramen Ovale (PFO) is a flap-like opening between the two upper chambers of the heart known as the left and right atria. A PFO is present in approximately 25% of the population. PFO is not a heart defect; it is a remnant of the foetal blood circulation. In the womb, all babies have this opening to allow the circulation to bypass the lungs. After birth this flap normally closes to form a solid wall (called a septum) between the chambers. If the PFO does not close, the opening can permit venous blood, normally filtered by the lungs, to pass unfiltered into the left atrium and out to the body, including the brain. PFO is associated with a number of medical conditions including Migraine, Decompression Illness, Stroke and other thrombo-embolic events. 

For more information, please see our webpage on PFO. 

http://www.sharpecardiology.com.au/services-consultations%20-%20migraine.htm