Document Detail

Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of different procedures and different contrast agents.
MedLine Citation:
PMID:  10471431     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Cardiac right-to-left shunts can be identified by transesophageal echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of different contrast agents and different provocation procedures. Currently, data on an appropriate time window for the appearance of contrast bubbles in the TCD recording after the injection of the contrast medium and the comparison of different provocation maneuvers to increase right-to-left shunting are insufficient. METHODS: Forty-six patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with 6 injection modes was applied in a randomized way: (1) injection of 10 mL of agitated saline without Valsalva maneuver, (2) injection of 10 mL of agitated saline with Valsalva maneuver, (3) injection of 10 mL of a commercial galactose-based contrast agent (Echovist) without Valsalva maneuver, (4) injection of 10 mL of Echovist with Valsalva maneuver, (5) injection of 10 mL of Echovist with standardized Valsalva maneuver, and (6) injection of 10 mL of Echovist with coughing. RESULTS: In 20 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt-positive). Sixteen patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 10 patients were only positive on at least 1 TCD investigation but negative during TEE. The amount of microbubbles detected in the various tests decreased in the following order: Echovist and Valsalva maneuver, Echovist with coughing, Echovist and standardized Valsalva maneuver, saline with Valsalva maneuver, Echovist, and saline. With a time window of 20 to 25 seconds for the bubbles to appear in the TCD recording and with a sequence of first Echovist and Valsalva maneuver and then Echovist with coughing, all shunts were reliably identified with a specificity of 65% compared with TEE as the traditional gold standard. The time of first microbubble appearance was not helpful to distinguish between shunts detected on TEE and other shunts. CONCLUSIONS: TCD performed twice with 2 provocation maneuvers using Echovist is a sensitive method to identify cardiac right-to-left shunts also identified by TEE.
D W Droste; J U Kriete; J Stypmann; M Castrucci; T Wichter; R Tietje; B Weltermann; P Young; E B Ringelstein
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial    
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  30     ISSN:  0039-2499     ISO Abbreviation:  Stroke     Publication Date:  1999 Sep 
Date Detail:
Created Date:  1999-10-08     Completed Date:  1999-10-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1827-32     Citation Subset:  IM    
Department of Neurology, University of Münster Germany.
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MeSH Terms
Contrast Media*
Dose-Response Relationship, Drug
Echocardiography, Transesophageal
Heart Septal Defects, Atrial / diagnosis,  ultrasonography*
Middle Aged
Polysaccharides / administration & dosage,  diagnostic use
Sensitivity and Specificity
Sodium Chloride / administration & dosage,  diagnostic use
Ultrasonography, Doppler, Transcranial* / methods
Valsalva Maneuver
Reg. No./Substance:
0/Contrast Media; 0/Polysaccharides; 7647-14-5/Sodium Chloride; 90881-70-2/SHU 454

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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