| Contrast transcranial Doppler ultrasound in the detection of right-to-left shunts: comparison of Echovist-200 and Echovist-300, timing of the Valsalva maneuver, and general recommendations for the performance of the test. | |
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MedLine Citation:
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PMID: 12011547 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND AND PURPOSE: Cardiac right-to-left shunts (RLS) can be identified by transesophageal echocardiography (TEE) as well as by transcranial Doppler ultrasound (TCD) using contrast agents, such as Echovist-200 or Echovist-300 in conjunction with a Valsalva maneuver (VM) as provocation procedure. Both Echovist preparations are in use. Currently, the appropriate timing of the VM is still under debate. METHODS: Sixty-four patients were investigated by both TEE and bilateral TCD of the middle cerebral arteries. The following protocol was applied in a randomized way: (1) no VM, (2) VM for 5 s starting with the beginning of Echovist-300 injection, (3) VM for 5 s starting 5 s after the beginning of Echovist-300 injection, (4) VM for 5 s starting 10 s after the beginning of Echovist-300 injection, and (5) VM for 5 s starting 5 s after the beginning of Echovist-200 injection. RESULTS: In 27 patients, an RLS was demonstrated by both TEE and contrast TCD (shunt-positive). Twenty-two patients were negative in both investigations, no patient was positive on TEE but negative on TCD, 15 patients were only positive on at least one TCD investigation but negative on TEE. Tests 3 and 5 were the most appropriate ones; test 3 was slightly superior to test 5. CONCLUSIONS: TCD using Echovist-300 or Echovist-200 is a sensitive method to identify TEE-proven cardiac RLS. To achieve the best diagnostic accuracy, the VM should be performed for a duration of 5 s starting at 5 s following the beginning of contrast injection. |
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Authors:
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Dirk W Droste; Ruta Jekentaite; J?rg Stypmann; Matthias Grude; Tjark Hansberg; Martin Ritter; Darius Nabavi; Eun-Mi Nam; Ralf Dittrich; Thomas Wichter; E Bernd Ringelstein |
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Publication Detail:
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Type: Clinical Trial; Comparative Study; Journal Article; Randomized Controlled Trial; Validation Studies |
Journal Detail:
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Title: Cerebrovascular diseases (Basel, Switzerland) Volume: 13 ISSN: 1015-9770 ISO Abbreviation: Cerebrovasc. Dis. Publication Date: 2002 |
Date Detail:
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Created Date: 2002-05-15 Completed Date: 2002-11-22 Revised Date: 2010-03-24 |
Medline Journal Info:
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Nlm Unique ID: 9100851 Medline TA: Cerebrovasc Dis Country: Switzerland |
Other Details:
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Languages: eng Pagination: 235-41 Citation Subset: IM |
Copyright Information:
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Copyright 2002 S. Karger AG, Basel |
Affiliation:
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Department of Neurology, University of M?nster, M?nster, Germany. droste2@uni-muenster.de |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Adult Aged Cerebral Arterial Diseases / complications, diagnosis Contrast Media* Echocardiography, Transesophageal Embolism, Paradoxical / complications, diagnosis Female Heart Septal Defects, Atrial / complications, diagnosis Humans Male Middle Aged Middle Cerebral Artery / ultrasonography Polysaccharides / diagnostic use* Reproducibility of Results Sensitivity and Specificity Time Factors Ultrasonography, Doppler, Transcranial* Valsalva Maneuver / drug effects, physiology |
| Chemical | |
Reg. No./Substance:
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0/Contrast Media; 0/Polysaccharides; 90881-70-2/SHU 454 |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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