Optimized transcranial Doppler technique for the diagnosis of cardiac right-to-left shunts

被引:19
作者
Albert, A [1 ]
Muller, HR [1 ]
Hetzel, A [1 ]
机构
[1] UNIV FREIBURG, DEPT NEUROL, D-7800 FREIBURG, GERMANY
关键词
D O I
10.1111/jon199773159
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Transcranial Doppler sonography (TCD) is a simple method to detect a right-to-left cardiac shunt, although standardized procedures do not exist. in this study 69 patients were tested according to predetermined criteria and procedures (cluster of >10 microbubbles, duration between injection in the cubital vein and detection in the middle cerebral artery [MCA] less than or equal to 10 sec). Agitated saline solution was compared to oxypolygelatine, a plasma volume expander, as contrast media. Valsalva's maneuver and coughing were used to provoke right-to-left cardiac shunting, detected by TCD, transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE). Oxypolygelatine caused a significantly higher number of microbubbles in the right atrium and MCA than did the saline solution, leading to a greater diagnostic reliability of TCD (paired t test, p < 0.001). Coughing did not provoke right-to-left cardiac shunts (chi(2) analysis, p < 0.001). The technique used for carrying out Valsalva's maneuver was important for the detection of right-to-left cardiac shunts. Twenty-five right-to-left shunts were diagnosed with TCD and 18 with TTE (36 vs 26%; chi(2) analysis, p = 0.1). The findings indicate that TCD when properly done is highly sensitive and specific for the diagnosis of right-to-left cardiac shunts.
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页码:159 / 163
页数:5
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