Transcranial Doppler Ultrasound to Find Patent Foramen Ovale Before Left Ventricular Assist Device Placement

Department

Neurology

Additional Department

Cardiology

Document Type

Article

Publication Title

Clinical Neuroimaging

Abstract

Background and purpose: Detection of patent foramen ovale (PFO) has become important with the increasing use of left ventricular assist devices (LVAD) for advanced heart failure. After LVAD implantation there may be increased right to left shunting through a PFO causing hypoxemia. Preoperative screening can identify PFO so that closure can be planned. Transcranial Doppler Ultrasound (TCD) with agitated saline has previously been shown to have high sensitivity for the detection of left-to-right shunt compared to transthoracic echocardiography (TTE) and is less invasive than transesophageal echocardiography (TEE). This study calculates sensitivity and specificity of TCD for PFO compared to the gold standard of intraoperative identification in patients receiving LVAD implantation.

Methods: The charts of 103 patients who underwent LVAD placement were reviewed. Preoperative TTE, TCD, and TEE reports were reviewed for the presence of right-to-left shunt or PFO, and this was compared to intraoperative detection of PFO.

Results: TTE was found to have a sensitivity of 26.7% and a specificity of 96.6%. TCD had a sensitivity of 33.3% and a specificity of 93.8%. Using TTE and TCD in combination resulted in a sensitivity of 43.8% and a specificity 91.9%. Sensitivity of TCD and TTE in this population was lower than that in published rates. This could be due to the high reliability of the gold standard, intraoperative detection, as well as altered hemodynamics in patients with advanced heart failure. Adding TCD to TTE improved sensitivity from 26.7% to 43.8%.

Conclusions: In patients undergoing LVAD implantation, relying solely on TTE for PFO detection may result in underdiagnosis. Combining TTE with TCD improves sensitivity without compromising specificity and should be considered to optimize preoperative screening and reduce the risk of postoperative complications.

First Page

e70052

DOI

10.1002/neo2.70052

Volume

3

Issue

1

Publication Date

1-30-2026

Link to Full Text

Share

COinS