DOPPLER COLOR-FLOW IMAGING - SCREENING OF A PATENT FORAMEN OVALE IN CHILDREN SCHEDULED FOR NEUROSURGERY IN THE SILTING POSITION

A patent foramen ovale (PFO) is the most common cause of paradoxical a ir embolism during neurosurgical procedures in the posterior fossa in the sitting position in both adults and children. To detect right-to-l eft shunting, we performed Doppler color-flow imaging preoperatively i n 30 children scheduled for neurosurgical procedures in the sitting po sition. A PFO was diagnosed on the basis of color alterations indicati ng an immediate blood shunt through a PFO. Six of 30 children (20%) ha d a PFO; in 4 of these children the sitting position then was avoided, and 2 children were operated on in a special supine position with min imal elevation of the head. Venous air embolism occurred in 9 of 24 (3 7%) children operated on in the sitting position and in none of the 6 children operated on in a nonsitting position. We conclude that Dopple r color-flow mapping could be a useful noninvasive technique to screen children scheduled for neurosurgery in the sitting position for the p resence of a PFO.