Should One Use Echocardiography or Contrast Transcranial Doppler Ultrasound for the Detection of a Patent Foramen Ovale after an Ischemic Cerebrovascular Accident?

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Abstract
Patent foramen ovale is frequently associated with embolic cerebrovascular accidents. The diagnosis of patent foramen ovale is easier since the advent of transesophageal echocardiography. However, this method is semi-invasive and is not readily available in all units. Contrast transcranial Doppler ultrasound enables the detection of the passage of a contrast material injected into a peripheral vein to the cerebral circulation across an orifice which is most often a patent foramen ovale. Contrast transcranial Doppler ultrasound may facilitate, with a high sensitivity and specificity, the diagnosis of a patent foramen ovale when a transesophageal echo is not possible. However, transesophageal echocardiography remains the preferred test especially in the young since other potentially embolic sources, such as a thrombus in the left atrium, may be demonstrable.