Document Detail


Right-to-left-shunts detected by transesophageal echocardiography and transcranial Doppler sonography.
MedLine Citation:
PMID:  14707421     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Transesophageal echocardiography (TEE) and transcranial Doppler sonography (TCD) can identify right-to-left-shunts that predispose to paradoxical embolism. In a large cohort we compared the results of both techniques. METHODS: 222 patients were investigated by both techniques using the contrast agent Echovist-300 and performing each test once without and once with the Valsalva maneuver (VM). RESULTS: TEE-proven right-to-left-shunts were detected by TCD with a high sensitivity of 94%. In addition, TCD revealed shunts not noted during TEE in about 20% of all patients studied. These shunts are in general smaller than those concordantly identified; however, 9% of the patients without a TEE-proven shunt presented with a shunt that allows a considerable amount of contrast medium to pass. There were 12% more microbubbles detected in the right middle cerebral artery than in the left middle cerebral artery during the TCD test performed with VM, but not during the TCD test performed without VM. CONCLUSIONS: Contrast-enhanced TEE and TCD are complementary methods in the assessment of stroke and stroke-prone patients. The side difference of microbubbles may indicate a selective streaming of cardiac emboli during VM.
Authors:
Dirk W Droste; Carsten Schmidt-Rimpler; Thomas Wichter; Ralf Dittrich; Martin Ritter; Jörg Stypmann; E Bernd Ringelstein
Publication Detail:
Type:  Clinical Trial; Comparative Study; Journal Article     Date:  2003-12-29
Journal Detail:
Title:  Cerebrovascular diseases (Basel, Switzerland)     Volume:  17     ISSN:  1015-9770     ISO Abbreviation:  Cerebrovasc. Dis.     Publication Date:  2004  
Date Detail:
Created Date:  2004-03-22     Completed Date:  2004-07-09     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  9100851     Medline TA:  Cerebrovasc Dis     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  191-6     Citation Subset:  IM    
Copyright Information:
Copyright 2004 S. Karger AG, Basel
Affiliation:
Department of Neurology, University of Münster, Germany. droste.dirk@chl.lu
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MeSH Terms
Descriptor/Qualifier:
Adolescent
Adult
Aged
Aged, 80 and over
Cohort Studies
Contrast Media
Echocardiography, Transesophageal*
Female
Heart Septal Defects, Atrial / ultrasonography*
Humans
Intracranial Embolism / ultrasonography*
Male
Middle Aged
Polysaccharides / diagnostic use
Sensitivity and Specificity
Ultrasonography, Doppler, Transcranial*
Chemical
Reg. No./Substance:
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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