LETTER
Searching for Patent Foramen Ovale in Patients with Stroke
Richard D. Layne
15 April 1993 | Volume 118 Issue 8 | Page 648
TO THE EDITOR:
Di Tullio and colleagues [1] found an association of cryptogenic stroke with right-to-left intracardiac shunt that was determined by contrast echocardiography and interpreted as an indication of patent foramen ovale. They concluded that "when a diagnostic work-up fails to reveal a cause for the stroke, patients, regardless of age, should have contrast echocardiography." They also suggested that a normal transthoracic contrast echocardiogram might be followed by transesophageal contrast echocardiogram to exclude a patent foramen ovale.
Even without the current close examination of the nation's health care expenditures, one must question these recommendations because, as they stated, "therapy for patients with ischemic stroke and patent foramen ovale remains unestablished." Indeed, the successful search for a patent foramen ovale puts the patient at risk for the costs and morbidity associated with consequent diagnostic and therapeutic measures, the utility of which is unproven. Starting down this road, then, breaks the eighth guideline for determining the clinical usefulness of a diagnostic test [2].
Until research establishes the utility of certain treatments, exhaustive searches for a patent foramen ovale cannot be considered a proven or prudent strategy.
1. Di Tullio M, Sacco RL, Gopal A, Mohr JP, Homma S. Patent foramen ovale as a risk factor for cryptogenic stroke. Ann Intern Med. 1992; 117:461-5.
2. Sackett DL, Haynes RB, Tugwell P. Clinical Epidemiology: A Basic Science for Clinical Medicine. Boston: Little, Brown; 1985:49.
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