Non-smoke spontaneous contrast in left atrium intensified by respiratory manoeuvres: a new transoesophageal echocardiographic observation.
Non-smoke spontaneous contrast in left atrium intensified by respiratory manoeuvres: a new transoesophageal echocardiographic observation.
复制标题
左心房的非烟雾自发对比因呼吸动作而增强：一种新的经食管超声心动图观察。
作者：
G. Van Camp;B. Cosyns;J. Vandenbossche
目的--阐明经食管超声心动图造影时左心房出现不同类型造影剂的原因。这将导致真正的卵圆孔未闭的更统一的定义。背景--Valsalva动作和咳嗽通常用于增强右向左分流以检测卵圆孔未闭。然而，没有关于这些操作对左心房血液固有回声的影响的信息。方法--对30例连续的经食管超声心动图患者进行了研究。增益设置相对较高，因此不会丢失任何细节。在正常呼吸、咳嗽和Valsalva动作期间，在静脉注射和不注射10 ml 5%葡萄糖的情况下，在左心房中观察造影剂的出现。左心房中造影剂出现的频率以百分比表示。当存在造影剂时，将造影剂强度分级为1级（轻度）、2级（中度）或3级（与注射期间的右心房造影剂相同）。在呼吸操作结束后的心动周期中评估时间。结果--左房造影剂表现为从右肺静脉向左房中部流动的“暴风雪”。在正常呼吸期间，分别有8名和5名患者在注射和不注射造影剂的情况下，在咳嗽期间分别有15名和7名患者，在Valsalva操作期间分别有20名和14名患者。当存在时，正常呼吸期间的平均对比强度为1.0，咳嗽期间为1.4，Valsalva动作期间为1.4。在Valsalva动作释放后和咳嗽发作后，造影剂出现的平均延迟为3-4个周期。结论--呼吸运动经常引起左心房轻度到中度造影剂的短暂出现，大多数情况下与静脉注射无关。仅在高增益设置下观察到轻度对比度。这种对比可能与肺循环中的短暂停滞有关。在某些情况下，外周静脉注射葡萄糖溶液在没有任何呼吸操作的情况下，在右心房充盈的前四个心动周期后产生类似的对比度，这可能代表注射的推注通过肺毛细血管床的再循环。因此，在注射造影剂之前应始终进行呼吸操作，以便更好地区分这种背景和真正的卵圆孔未闭或肺动静脉瘘。
OBJECTIVE--To elucidate why different types of contrast appear in the left atrium during transoesophageal echocardiographic contrast studies. This should lead to a more uniform definition of true patent foramen ovale. BACKGROUND--The Valsalva manoeuvre and cough are routinely used to enhance right to left shunt for the detection of patent foramen ovale. No information is, however, available on the effect of these manoeuvres on the intrinsic echogenicity of blood in the left atrium. METHODS--30 consecutive patients referred for transoesophageal echocardiography were studied. Gain settings were relatively high so that no details were lost. The appearance of contrast during normal respiration, cough, and the Valsalva manoeuvre was looked for in the left atrium with and without venous injection of 10 ml of 5% dextrose. Frequency of contrast appearance in the left atrium was expressed as a percentage. Intensity of contrast, when present, was graded 1 (mild), 2 (moderate), or 3 (equal to right atrial contrast during injection). Timing was assessed in cardiac cycles after the end of respiratory manoeuvres. RESULTS--Left atrial contrast appeared as a "snowstorm" flowing from the right pulmonary veins towards the middle of the left atrium. It was present respectively with and without contrast injection in eight and five patients during normal respiration, in 15 and seven during a cough, and in 20 and 14 during the Valsalva manoeuvre. When present, the mean intensity of contrast was 1.0 during normal respiration, 1.4 during a cough, and 1.4 during the Valsalva manoeuvre. The mean delay of contrast appearance was 3-4 cycles after release of the Valsalva manoeuvre and after onset of cough. CONCLUSIONS--Respiratory manoeuvres frequently induce the transient appearance of mild to moderate contrast in the left atrium, most often independently of venous injections. Mild contrast was seen only with high gain settings. This contrast is likely to be related to transient stasis in the pulmonary circulation. In some cases peripheral venous injections of dextrose solution produced, without any respiratory manoeuvre, a similar contrast after the first four cardiac cycles of the right atrium filling, which is likely to represent recirculation of the injected bolus through the pulmonary capillary bed. Therefore respiratory manoeuvres should always be performed before contrast injections to allow better distinction between this background and true patent foramen ovale or pulmonary arteriovenous fistula.
通过多普勒彩色血流图检测接受心导管插入术的患者的卵圆孔未闭。
DOI：
10.1016/0002-9149(91)90727-3
发表时间：
1991
期刊：
The American journal of cardiology
影响因子：
--
作者：
Brickner,ME;Grayburn,PA;Fadel,B;Carry,MM;Eichhorn,EJ;Lange,RA;Taylor,AL
通讯作者：
Taylor,AL
超声心动图“烟雾”是由剪切力调节的红细胞和血浆蛋白相互作用产生的。
影响因子：
24
作者：
Merino,A;Hauptman,P;Badimon,L;Badimon,JJ;Cohen,M;Fuster,V;Goldman,M
通讯作者：
Goldman,M