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Xu Y, Liu R. The prevalence of positive right to left shunt in migraine patients with and without aura: A new single-center study in China. Clin Neurol Neurosurg 2023; 235:108020. [PMID: 38344972 DOI: 10.1016/j.clineuro.2023.108020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/01/2023] [Accepted: 10/22/2023] [Indexed: 02/15/2024]
Abstract
BACKGROUND Recently, many studies have reported that there may be association between positive right-to-left shunt (RLS) and migraine, especially Migraine with aura (MA) patients. However, these researches are mostly limited in Western country. And the latest study describing the prevalence of RLS in Chinese patients with migraine was conducted five years ago. It indicated the significant higher rate of positive RLS in MA patients than migraine without aura(MWOA) group. However, no consistent results were observed according to our daily work. OBJECTIVE To investigate the prevalence and grade of RLS in migraine patients with and without aura and to evaluate the potential association between positive RLS and migraine with aura. METHODS A total of 91 migraine patients were involved, including 57 MWOA patients and 34 MA patients. MWOA and MA were diagnosed according to the International Classification of Headache Disorders, 3rd edition (beta version) (ICHD-3). Contrast transcranial Doppler ultra-sound (cTCD) was used to assess the prevalence of positive RLS, the associations between RLS and presence of aura. RESULTS The overall prevalence of RLS in migraine patients was 35.2%. In MA group, 44.1% (15/34) were positive for RLS overall, higher than MWOA group (29.8%,17/57). However, the differences were not significant (P = 0.167). And there were no marked differences in the prevalence of large, middle and small shunt between MA and MWOA patients. CONCLUSION Our study suggested MA patients have the slightly higher prevalence of positive RLS than MWOA patients in China. However, there were no significant differences, which was different from the previous studies. Our findings suggested the negative association between the positive RLS and migraine with aura.
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Affiliation(s)
- Yiyuan Xu
- Department of Function examination, Henan Provincial Hospital of Traditional Chinese Medicine, The Second Affiliated Hospital of Henan University of Chinese Medicine, Zhengzhou 450053, China.
| | - Rui Liu
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin 300052, China
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Maloku A, Hamadanchi A, Franz M, Dannberg G, Günther A, Klingner C, Schulze PC, Möbius-Winkler S. Patent foramen ovale-When to close and how? Herz 2021; 46:445-451. [PMID: 34463786 DOI: 10.1007/s00059-021-05061-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2021] [Indexed: 12/29/2022]
Abstract
Closure of a patent foramen ovale (PFO) in patients after cryptogenic/cardioembolic stroke is recommended by current guidelines for patients who are 16-60 years of age with a high-risk PFO (class of recommendation A, level of evidence I). The use of double-disk occlusion devices followed by antiplatelet therapy is recommended. The procedure of interventional PFO closure compared with other interventions in cardiology is rather easy to learn. However, it should be performed carefully to avoid postinterventional complications. The number needed to treat (NNT) to avoid one stroke in 5 years in the RESPECT trial was 42, in the CLOSE trial even lower with 20. In the REDUCE trial, the NNT was 28 at 2 years. This can be reduced by longer follow-up, e.g., at 10 years the NNT is 18. While other conditions such as migraine are currently under investigation with respect to the impact of PFO closure, sufficiently powered trials are lacking so that closure in diseases other than stroke should always be individualized.
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Affiliation(s)
- Aurel Maloku
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Ali Hamadanchi
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Marcus Franz
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Gudrun Dannberg
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Albrecht Günther
- Hans-Berger-Department of Neurology, University Hospital Jena, Jena, Germany
| | - Carsten Klingner
- Hans-Berger-Department of Neurology, University Hospital Jena, Jena, Germany
| | - P Christian Schulze
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany
| | - Sven Möbius-Winkler
- Department of Internal Medicine I, Cardiology, Angiology, Intensive Medical Care, University Hospital Jena, Am Klinikum 1, 07747, Jena, Germany.
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Hussain N, Hussain F, Malik A, Rizvi M, Patel P, Chittivelu S. A devastating cardiovascular event in an adult cystic fibrosis patient: An unforeseen outcome of increasing life expectancy. Respir Med Case Rep 2018; 25:233-234. [PMID: 30294539 PMCID: PMC6171483 DOI: 10.1016/j.rmcr.2018.09.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Revised: 09/18/2018] [Accepted: 09/18/2018] [Indexed: 11/30/2022] Open
Abstract
The improving life expectancy for CF is known to be one of the biggest success stories in medicine. Life expectancy has increased from 6 months during the early 20th century to 42.7 years from in 2012-2016. As the life expectancy of CF patients has increased, it is important to consider other co-morbidities that these patients may encounter, and the impact this may have on their morbidity and mortality. We present a case of a 33-year-old male admitted to the hospital for a CF exacerbation who had an acute neurological decompensation due to an infarction of his right occipital and posterior temporal lobe.
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Affiliation(s)
- Nooreen Hussain
- Department of Internal Medicine; University of Illinois College of Medicine at Peoria, USA
| | - Faiz Hussain
- Internal Medicine, Advanced Cancer Care Center Illinois, USA
| | - Abdullah Malik
- Department of Internal Medicine; University of Illinois College of Medicine at Peoria, USA.,Department of Pediatric Medicine; University of Illinois College of Medicine at Peoria, USA
| | - Muaz Rizvi
- Department of Pediatric Medicine; University of Illinois College of Medicine at Peoria, USA
| | - Preeti Patel
- Department of Critical Care/Pulmonary Medicine; University of Illinois College of Medicine at Peoria, USA
| | - Subramanyam Chittivelu
- Department of Critical Care/Pulmonary Medicine; University of Illinois College of Medicine at Peoria, USA
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Sadrameli SS, Gadhia RR, Kabir R, Volpi JJ. Patent Foramen Ovale in Cryptogenic Stroke and Migraine with Aura: Does Size Matter? Cureus 2018; 10:e3213. [PMID: 30405989 PMCID: PMC6205877 DOI: 10.7759/cureus.3213] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction: There is an association between cryptogenic strokes and patent foramen ovale (PFO), as well as between migraines with aura and PFO. The purpose of the current study was to compare shunt characteristics in the stroke and migraine populations. Methods: We retrospectively evaluated the degree of the shunt in 68 consecutive patients with cryptogenic stroke (n=33) or migraines with aura (n=35) evaluated in a single transcranial Doppler laboratory. All patients underwent an intravenous injection of agitated saline, followed by the insonation of the middle cerebral artery to determine the degree of the right-to-left shunt. We graded the shunt size according to the number of emboli: Grade I, none; Grade II, 1-10; Grade III, 11-100; and Grade IV, >100. Grades I and II were considered low-grade shunts, and Grades III and IV were considered high-grade. Results: In the 14-month study period, we found 31 high-grade shunts and 37 low-grade shunts. Among migraines with aura patients, 27 (77%) had high-grade shunts, whereas only 4 patients (12%) with cryptogenic stroke had high-grade shunts. These percentages were significantly different between groups (Fisher’s exact test, p<0.0001). Conclusions: In a standardized laboratory using uniform methods, we found a significant difference in shunt size associated with PFO between cryptogenic stroke and migraine with aura patients. We hypothesize that in migraines with aura, venous admixture with arterial blood is the main mechanism by which PFO contributes to the condition. In contrast, cryptogenic strokes associated with PFO are more likely to arise from an atrial septal clot within the PFO space.
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Affiliation(s)
- Saeed S Sadrameli
- Neurosurgery, Houston Methodist Neurological Institute, Houston, USA
| | - Rajan R Gadhia
- Neurology, Houston Methodist Neurological Institute, Houston, USA
| | - Rasadul Kabir
- Radiology, Houston Methodist Neurological Institute, Houston, USA
| | - John J Volpi
- Neurology, Houston Methodist Neurological Institute, Houston, USA
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Abstract
Migraine headache is a common and debilitating disease that has a demonstrable association with the presence of patent foramen ovale (PFO) in multiple case series. Closure of PFO has been performed to try to treat migraine with aura, with variable results. Although early trials suggested benefit to PFO closure, these were of poor quality, and subsequent randomized trials have failed to yield positive results. This article discusses the evidence of an association with PFO and migraine headache, and the trials that have so far been performed to assess the benefits of closure.
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Affiliation(s)
- David Hildick-Smith
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK.
| | - Timothy M Williams
- Sussex Cardiac Centre, Brighton and Sussex University Hospitals, Eastern Road, Brighton, BN2 5BE, UK
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6
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Ghazal SN. Valsalva maneuver in echocardiography. J Echocardiogr 2016; 15:1-5. [PMID: 27515556 DOI: 10.1007/s12574-016-0310-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 07/13/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
The Valsalva maneuver is an easily performed maneuver with an interesting hemodynamic effect which can be used to aid accurate echocardiographic diagnosis. However, correct adequate performance is often missed. Here, we aim to describe the performance of an adequate Valsalva maneuver and the correct interpretation of its effect. The Valsalva hemodynamic effect consists of four basic phases which can be used in echocardiography to yield an accurate diagnosis. Valsalva is used to decrease preload and provoke left ventricular outflow tract (LVOT) gradient in dynamic LVOT obstruction. In addition, a decrease in E/A ratio in mitral inflow >50 % with Valsalva correlates with increased LV filling pressure and diastolic dysfunction. Valsalva also momentarily increases RA pressure and helps to unmask a patent foramen ovale with the use of saline contrast.
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Affiliation(s)
- Sami Nimer Ghazal
- Cardiology Division, Internal Medicine Department, King Fahd Hospital of the University, University of Dammam, P.O. Box 2208, Al-Khobar, 31952, Saudi Arabia.
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Fadel BM, Husain A, Bakarman H, Dahdouh Z, Salvo GD, Mohty D. Spectral Doppler interrogation of the patent foramen ovale-a window to left heart hemodynamics. Echocardiography 2014; 32:383-9. [PMID: 25130954 DOI: 10.1111/echo.12723] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Spectral Doppler interrogation of flow across a patent foramen ovale (PFO) allows recording of the instantaneous pressure gradient between left and right atrium (RA). The assessment of RA pressure using the size and collapsibility of the inferior vena cava would thus allow estimation of left atrial (LA) pressure. In this article, we illustrate the value of spectral Doppler interrogation of flow across the PFO by transthoracic echocardiography as a novel and simple tool for the assessment of LA pressure and left cardiac hemodynamics in addition to the conventional noninvasive parameters.
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Affiliation(s)
- Bahaa M Fadel
- King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
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Importance of Adequately Performed Valsalva Maneuver to Detect Patent Foramen Ovale during Transesophageal Echocardiography. J Am Soc Echocardiogr 2013; 26:1337-43. [DOI: 10.1016/j.echo.2013.07.016] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Indexed: 02/06/2023]
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Ren P, Li K, Lu X, Xie M. Diagnostic value of transthoracic echocardiography for patent foramen ovale: a meta-analysis. ULTRASOUND IN MEDICINE & BIOLOGY 2013; 39:1743-1750. [PMID: 23820251 DOI: 10.1016/j.ultrasmedbio.2013.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/22/2012] [Revised: 03/06/2013] [Accepted: 03/08/2013] [Indexed: 06/02/2023]
Abstract
As a non-invasive and convenient modality, transthoracic echocardiography (TTE) has been widely recommended for the diagnosis of patent foramen ovale (PFO). In this study our aim was to systematically review the diagnostic accuracy of TTE in detection of PFO. We conducted comprehensive searches in PubMed, Embase and the Cochrane Library to the end of September 1, 2012. Sixteen studies comprising 1831 patients were included in the meta-analysis. The quality of reported studies was modest. The summary sensitivity and specificity of TTE in diagnosis of PFO were 88% (95% confidence interval [CI], 79-94) and 97% (95% CI, 92-99), respectively. The positive likelihood ratio was 27.1 (95% CI, 11.2-65.1), and the negative likelihood ratio was 0.12 (95% CI, 0.07-0.22). The summary diagnostic odds ratio was 221 (95% CI, 95-518). Subgroup analyses suggested that age and initial disease may affect the accuracy of TTE in detection of PFO. The meta-analysis suggested that TTE is a test with high sensitivity and specificity in detection of PFO, but it may not be appropriate for screening for PFO in all patients, especially patients with a small right-left shunt.
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Affiliation(s)
- Pingping Ren
- Department of Ultrasonography, Union Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Sathasivam S, Sathasivam S. Patent foramen ovale and migraine: What is the relationship between the two? J Cardiol 2013; 61:256-9. [DOI: 10.1016/j.jjcc.2012.12.005] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2012] [Revised: 11/23/2012] [Accepted: 12/04/2012] [Indexed: 01/16/2023]
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Yang Y, Guo ZN, Wu J, Jin H, Wang X, Xu J, Feng J, Xing Y. Prevalence and extent of right-to-left shunt in migraine: a survey of 217 Chinese patients. Eur J Neurol 2012; 19:1367-72. [PMID: 22747847 DOI: 10.1111/j.1468-1331.2012.03793.x] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2012] [Accepted: 05/23/2012] [Indexed: 11/30/2022]
Abstract
BACKGROUND Recently, contrast-enhanced transcranial Doppler (cTCD) studies have shown that right-to-left shunt (RLS) may be a risk factor for migraine in Westerners; however, limited data in the literature describes the prevalence of RLS in Chinese patients with migraine. OBJECTIVE To assess the prevalence of RLS in patients with migraine in China and to evaluate the relationship between the extent of RLS and migraine. METHODS A total of 217 consecutive patients with a diagnosis of migraine and 100 volunteers were recruited. cTCD was used to assess the prevalence and the extent of RLS in all subjects. RESULTS In the migraine group, the rate of positive RLS was 44.2% (96/217), with 23.5% (51/217) of these being large. In the healthy group, 28.0% (28/100) were positive for RLS overall, and 5.0% (5/100) were large (P = 0.006; P < 0.001). In patients having migraines with aura (MwA), 66.1% (39/59) were positive for RLS overall, and 37.3% (22/59) were large, which was significantly higher when compared with the healthy group (P < 0.001; P < 0.001); in patients having migraines without aura (MwoA), 36.1% (57/158) were positive for RLS overall, and 18.4% (29/158) were large, which was against significantly higher (P < 0.001; P = 0.003). In the MwoA group, the large RLS rate was also higher than in the healthy group (P = 0.002). CONCLUSIONS A close correlation has been documented between RLS and migraine, especially MwA, but these relationships exist only when the shunts were large.
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Affiliation(s)
- Y Yang
- Department of Neurology, The First Norman Bethune Hospital of Jilin University, Chang Chun, China
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Yastrebov K, Sader M, Youssef G, Nojoumian H. Dynamic echocardiography in evaluation of platypnoea-orthodeoxia. Australas J Ultrasound Med 2012; 15:71-75. [PMID: 28191146 PMCID: PMC5025116 DOI: 10.1002/j.2205-0140.2012.tb00230.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Platypnoea‐orthodeoxia is an infrequent syndrome that is usually associated with positional intracardiac right‐to‐left shunting. The authors report the case of a patient who presented with deteriorating severe dyspnoea and deoxygenation in the upright position that was partially relieved by recumbent repositioning. Dynamic echocardiography provided insight into the underlying anatomical and pathophysiological mechanisms as well as guidance for definitive therapy.
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Affiliation(s)
- Konstantin Yastrebov
- Division of Intensive Care St George Hospital Kogarah New South Wales 2217 Australia
| | - Mark Sader
- Division of Cardiology St George Hospital Kogarah New South Wales 2217 Australia
| | - George Youssef
- Division of Cardiology St George Hospital Kogarah New South Wales 2217 Australia
| | - Haidy Nojoumian
- Division of Cardiology St George Hospital Kogarah New South Wales 2217 Australia
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Right-to-left shunts and micro-embolization in migraine. Curr Opin Neurol 2012; 25:263-8. [PMID: 22449873 DOI: 10.1097/wco.0b013e3283524103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The present review covers the latest studies on right-to-left shunts (RLSs) in migraine patients and different types of emboli capable of triggering migraine. RECENT FINDINGS Although three recent studies found no increased RLS prevalence in migraine with aura patients, there remains ample evidence that the prevalence of RLS is increased in migraine with aura. Introduced emboli in the carotid artery of mice have been shown to cause cortical spreading depression, which has been considered the pathophysiological mechanism of migraine aura. In humans, iatrogenic introduced (micro)-emboli can provoke migraine attacks; available evidence, however, is limited. SUMMARY RLS and migraine with aura (but not without) are comorbid conditions, but the biological mechanism remains speculative. Specific emboli are probably able (although infrequently) to induce migraine symptoms. There is no convincing evidence that closure of a RLS alters migraine frequency; therefore, diagnosis or treatment of RLS in migraine has no place in daily clinical practice and should only take place in controlled studies.
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Sharma A, Gheewala N, Silver P. Role of patent foramen ovale in migraine etiology and treatment: a review. Echocardiography 2011; 28:913-7. [PMID: 21827543 DOI: 10.1111/j.1540-8175.2011.01460.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
An increased prevalence between patent formen ovale (PFOs) and migraine exists but there is conflicting data regarding causal relationship between these two conditions. It is controversial whether cardiac screening and intervention like PFO closure provides any benefit in this population and so this area still remains under intense investigation. The management of migraine lies at the intersection between the practice of primary care physicians, neurologists, and cardiologists. There is no consensus as to what is the best practice for the evaluation of these patients with difficult to control migraine given the millions of dollars spent on physician visits and pharmacotherapy. This review seeks to summarize the current literature on this association and studies that have investigated PFO closure in this population.
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Affiliation(s)
- Ambika Sharma
- George Washington University School of Medicine, Washington, DC, USA.
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Armstrong ADC, Granja FAA, Pereira VC, Gomes Sá R, Fausto CAS, Armstrong DMFDO. Thrombus Entrapped in a Patent Foramen Ovale with Pulmonary and Systemic Embolism. Echocardiography 2011; 28:E129-30. [DOI: 10.1111/j.1540-8175.2011.01400.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Naqvi TZ. Pitfalls in Echocardiographic Diagnosis of Patent Foramen Ovale by Transesophageal Echocardiography. J Am Soc Echocardiogr 2011; 24:348; author reply 348-9. [DOI: 10.1016/j.echo.2010.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2010] [Indexed: 10/18/2022]
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