Abstract
Purpose
Patients with chronic venous insufficiency have been successfully treated with foam sclerotherapy. Reports of cerebral and respiratory symptoms after the foam procedure have been related to an open foramen ovale (PFO) between the right and left sides of the heart. This work evaluated the value of ultrasonography to demonstrate that bubbles may traverse a PFO and may be detected at the middle cerebral artery.
Methods
Patients describing cerebral or respiratory symptoms or suspected of having a PFO entered this study. Cerebral symptoms included visual disturbance, lightheadedness, dizziness and migraine. Respiratory problems included cough. A total of 20 patients had transthoracic echocardiography (TTE), and 12 had transcranial Doppler (TCD) of the middle cerebral artery.
Results
TTE detected bubbles in the left heart in 13 (65%) of 20 patients. The 12 TCDs were performed in nine patients with positive and three with negative TTE evaluation; five TCDs were positive for emboli at the middle cerebral artery. All five patients had positive transthoracic echocardiography.
Conclusions
This single-institution evaluation for quality control demonstrated that 1) patients with cerebral or respiratory symptoms after foam sclerotherapy may have PFO; and 2) patients with patent PFO may embolize the gas particles to the brain. Therefore, patients with known PFO must be evaluated before foam injection, and patients that are candidates for this treatment may have to be screened for PFO.
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