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Título

ANALYSIS OF THE FUNCTIONAL CHARACTERISTICS OF THE PATENT FORAMEN OVAL AND DIAGNOSTIC ACCURACY USING CONTRASTED TRANSCRANIAL DOPPLER

Resumo

Introduction: Patent foramen ovale (PFO) is an interatrial embryonic remnant that results in right-to-left circulation (RLC) communication, therefore associated with paradoxical embolism events. It is associated with cases of stroke of undetermined source in young people, although it is present in about 30% of the general population and its incidental finding in complementary exams is common. The causal relationship has been explored in many studies, and the search for high-risk markers is the subject of numerous meta-analyses. Contrast-enhanced transcranial Doppler (cTCD) is considered the screening test of choice because it is a low-cost, non-invasive diagnostic tool with high sensitivity and specificity. Methodology: The database of the Neurosonology Laboratory of the Hospital de Clínicas of the Federal University of Paraná was used, with a review of information from 901 patients from January 2015 to May 2019. Of the total, 701 patients who underwent cTCD were included and 551 who had a complementary investigation with transthoracic echocardiography (TTE) or contrast transesophageal echocardiography (c-TEE). The functional pattern by the cTCD followed criteria previously published in the Latin American Consensus. Results: Our study showed a significant difference in the “curtain” pattern at rest in the cerebrovascular disease group when compared to migraine with aura and incidental finding groups. In the evaluation of the subgroup that performed the cTCD and c-TEE, we found a high sensitivity and specificity of the cTCD when compared with the gold standard exam. Conclusion: The “curtain” rest pattern resulted in the greatest association of functional risk for the event related to cerebrovascular disease and can be considered a high-risk characteristic. Comparison of diagnostic tests for RLC resulted in a sensitivity of 98.6% and a specificity of 91.3%, with a PPV of 96% and a NPV of 96.9%.