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Detection of Patent Foramen Ovale: Transcranial Doppler and Echocardiography Are Not Equivalent to Define a Large

Thomas Codant1, Pauline Renou2, Georgios Papaioannou1

  • 1Service de Médecine Vasculaire, Hôpital Saint-André, Bordeaux, France.

Journal of Clinical Ultrasound : JCU
|May 28, 2026
PubMed

Insights

The number of bubbles indicating a significant shunt differs between echocardiography and transcranial Doppler (TCD) when assessing patent foramen ovale (PFO). Echocardiography uses a threshold of 20 bubbles, while TCD requires 60 bubbles for PFO closure decisions.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Patent foramen ovale (PFO) closure decisions rely on shunt assessment via bubble studies using echocardiography or transcranial Doppler (TCD).
  • Current practice assumes identical bubble count thresholds for both echocardiography (TTE/TEE) and TCD.
  • This study investigates the validity of these shared thresholds.

Purpose of the Study:

  • To determine if the established bubble count thresholds for PFO closure are equivalent between echocardiography and TCD.
  • To analyze the relationship between bubble counts obtained from TCD and echocardiography in patients with PFO.

Main Methods:

  • A comparative observational study was conducted.
  • A linear regression model was employed to analyze the relationship between bubble counts from TCD and echocardiography (TTE/TEE).

Main Results:

  • A systematic difference in bubble counts was observed between TCD and echocardiography within the same patients.
  • Linear regression yielded the equation: TCD Estimate = (7.2 + 2.67 × TTE/TEE), indicating a significant relationship (p < 0.001).

Conclusions:

  • The study concludes that different thresholds are necessary for PFO closure decisions based on the imaging modality used.
  • Recommended thresholds are 20 bubbles for echocardiography and 60 bubbles for TCD.
Abstract

Keywords:
echocardiographymicrobubblespatent foramen ovaletranscranial dopplerultrasound

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