Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts
Optimizing the technique of contrast transcranial Doppler ultrasound in the detection of right-to-left shunts
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DOI：
10.1161/01.str.0000027884.03365.ac
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发表时间：
2002-09-01
期刊：
影响因子：
8.3
通讯作者：
Ringelstein, B
中科院分区：
文献类型：
--
作者：
Droste, DW;Lakemeier, S;Ringelstein, B
背景和目的：心脏右向左分流（RLS）可以通过经食管超声心动图和经颅多普勒超声（TCD）与造影剂和Valsalva动作（VM）作为激发程序来识别。本文将这些在以前的研究中详细描述的检查方法应用于一个大型患者队列，并比较了2种造影剂方法：81例患者同时进行经食管超声心动图和双侧大脑中动脉TCD检查。VM持续5秒，从造影剂注射开始后5秒开始，以及（3）如果VM的第一次测试为阴性，则用VM重复测试。VM在盐水注射开始后正好5秒开始进行5秒。此后，用10 ml重复相同的方案，Echovist 300代替生理盐水结果-31例患者有心脏RLS，Echovist 300研究显示了所有这31个分流，但生理盐水仅显示了其中的29个。22例患者仅在上述TCD检查中的至少一项中有RLS，其中一些患者结论-使用Echovist 300而非生理盐水进行的对比TCD识别经食管超声心动图的灵敏度为100%-经证实的心脏RLS如果第一次阴性，应重复TCD检查。本文提供了TCD造影技术优化的详细信息。仅在TCD造影期间检测到的心外分流可能具有相当大的分流量，可能导致反常栓塞
Background and Purpose-A cardiac right to left shunt (RLS) can be identified by transesophageal echocardiography and transcranial Doppler ultrasound (TCD) with contrast agents and a Valsalva maneuver (VM) as a provocation procedure This article applies the modalities of these tests detailed in previous studies to a large patient cohort and compares 2 contrast agents (saline and Echovist 300)Methods-Eighty one patients were investigated by both transesophageal echocardiography and bilateral TCD of the middle cerebral arteries The following protocol with injections of 10 mL agitated saline was applied in a randomized way (1) no VM (2) VM for 5 seconds starting 5 seconds after the beginning of contrast injection and (3) repetition of the test with VM if the first test with VM was negative The VM was performed for 5 seconds starting exactly 5 seconds after the beginning of saline injection Thereafter the same protocol was repeated with 10 ml, Echovist 300 instead of salineResults-Thirty one patients had a cardiac RLS The Echovist 300 investigation disclosed all these 31 shunts but saline disclosed only 29 of them Twenty two had an RLS only in at least 1 of the above TCD tests some of them even with a considerable shunt volumeConclusions-Contrast TCD performed with Echovist 300 but not with saline yields a 100% sensitivity to identify transesophageal echocardiography-proven cardiac RLSs The TCD test should be repeated if negative the first time This article gives detailed information for the optimization of the contrast TCD technique Extracardiac shunts detected only during contrast TCD can have a considerable shunt volume and may allow for paradoxical embolism.