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Effects of Posture on Right-to-Left Shunt Detection by Contrast Transcranial Doppler.
MedLine Citation:
PMID:  21757670     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND AND PURPOSE: There is controversy about the optimal patient position for the detection of right-to-left shunt (RLS). The study was performed to investigate which patient position best detects RLS during contrast-enhanced transcranial Doppler. METHODS: We prospectively evaluated consecutive patients with ischemic stroke or TIA referred to our Noninvasive Cerebrovascular Laboratory for suspected paradoxical embolism. The standard protocol for RLS detection recommended by the International Consensus Criteria was followed. Each patient was examined at rest and after Valsalva maneuver in 4 positions: supine, right lateral decubitus, right lateral leaning, and upright sitting, in random order. RLS was graded 0 (no microbubbles [mB] detected), 1 (1-10 mB), 2 (>10 mB but no curtain), and 3 (curtain, shower of mB). Blood pressure, heart rate, and neurological symptoms were monitored. Data were analyzed using SPSS version 17. RESULTS: RLS was detected in at least 1 position in 89 of 240 patients (37.1%; 95% CI, 33.1%-43.3%). The detection of at least 1 mB with normal breathing was lowest in supine position and highest in right lateral decubitus. With Valsalva maneuver, this was highest in upright sitting (20.4% versus 8.3%; P<0.0002). If mB were undetected on upright sitting position, then they may still be detected in other positions. Changes in the position of the body and the injection of agitated saline were well-tolerated. CONCLUSIONS: RLS is best detected in the upright sitting position with Valsalva maneuver. If negative, then other positions may be used. Validation of our findings by other centers may be helpful.
Authors:
Sherwin Joy U Agustin; Maricar P Yumul; Angelito Jonas L Kalaw; Boon Choon Teo; Johnny Eng; Ziqun Phua; Rajinder Singh; Robert N Gan; Narayanaswamy Venketasubramanian
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-7-14
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  -     ISSN:  1524-4628     ISO Abbreviation:  -     Publication Date:  2011 Jul 
Date Detail:
Created Date:  2011-7-15     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
From the Research Department, National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology and Psychiatry, University Of Santo Tomas Hospital, Manila, Philippines; Neurodiagnostic Laboratory, National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Department of Neurology, National Neuroscience Institute Tan Tock Seng Hospital Campus, Singapore; Lundbeck International Clinical Research, Asia Pacific-Regional Medical Center, Singapore; Division of Neurology, University Medical Cluster, National University Health System, National University of Singapore, Singapore.
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