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Provocative maneuvers to improve patent foramen ovale detection: A brief review of the literature
Author(s) -
Thiagaraj Ashwin K.,
HughesDoichev Rachel,
Biederman Robert W. W.
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14297
Subject(s) - patent foramen ovale , decompression illness , medicine , percutaneous , valsalva maneuver , shunt (medical) , paradoxical embolism , decompression sickness , right to left shunt , provocation test , cardiology , decompression , surgery , alternative medicine , pathology , blood pressure
Patent foramen ovale ( PFO ) is the most common type of inter‐atrial shunt, with prevalence as high as 30%. Detection of PFO has implications in patients with stroke, peripheral embolism, decompression illness, and other conditions. Transesophageal echo ( TEE ) with saline contrast injection is the current standard for PFO detection, but even with TEE , PFO s are sometimes missed. With advances in percutaneous PFO closure therapies and proven long‐term benefit of closure, accurate PFO detection takes on cardinal importance. Various provocative maneuvers to enhance PFO detection are in clinical use and have been studied. The Valsalva maneuver has long‐held position as the ideal provocation to unmask PFO , but other maneuvers such as cough, sniff, Müller's, and more have gained relevance. In this article, we will examine various maneuvers and discuss their utility in PFO detection.