Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts.
Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts.
复制标题
DOI：
10.1016/s1525-2167(03)00076-3
复制
发表时间：
2004-06-01
期刊：
影响因子：
--
通讯作者：
Banning, A P
中科院分区：
文献类型：
--
作者：
Clarke, N R A;Timperley, J;Banning, A P
目标：评估经胸超声心动图（TTE）使用二次谐波成像与Valsalva操作相比，经食管超声心动图（TEE）诊断右至左心脏和肺shunts.METHODS和结果：110例患者转介TEE进行TTE气泡造影。三个心动周期内左心房内出现气泡被认为是卵圆孔未闭（PFO）的诊断，后来被认为是肺分流。左心房内大于20个气泡被视为大分流，小于20个被视为小分流。之后立即进行TEE，并对TTE结果设盲。19例TEE阳性（13例PFO）和18例TTE阳性（14例PFO）患者的检出率相似。有5例TEE阳性/TTE阴性病例的TTE图像质量评分明显较差（2.7 +/- 0.8 vs 1.9 +/- 0.6，p < 0.05）。有6例TEE阴性/TTE阳性病例，2例需要Valsalva操作才能变为阳性。Valsalva操作明显增加了气泡分流的数量（10 +/- 11 vs 20 +/- 19，p < 0.005）。结论：Valsalva操作TTE在诊断分流方面与TEE一样好。Valsalva动作增加分流的大小。这两种技术都会产生假阴性结果。
AIMS: To assess transthoracic echocardiography (TTE) using second harmonic imaging with Valsalva manoeuvre compared to transesophageal echocardiography (TEE) for the diagnosis of right to left cardiac and pulmonary shunts.METHODS AND RESULTS: One hundred and ten patients referred for TEE underwent TTE with bubble contrast. Bubbles in the left atrium within three cardiac cycles were considered diagnostic for a patent foramen ovale (PFO) and later as a pulmonary shunt. Greater than 20 bubbles in the left atrium was considered a large shunt and less than 20 a small shunt. TEE was performed immediately afterwards and read blinded to the TTE results. Pick-up rates were similar with 19 TEE positive (13 PFO) and 18 TTE positive (14 PFO) patients. There were five TEE positive/TTE negative cases who had significantly poorer TTE image quality score (2.7 +/- 0.8 vs 1.9 +/- 0.6, p < 0.05). There were six TEE negative/TTE positive cases, two cases requiring Valsalva manoeuvre to become positive. The Valsalva manoeuvre significantly increased the number of bubbles shunting (10 +/- 11 vs 20 +/- 19, p < 0.005).CONCLUSION: TTE with Valsalva manoeuvre is as good as TEE in diagnosing shunts. Valsalva manoeuvre increases the size of shunt. Both techniques produce false negative results.