Document Detail

Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts.
MedLine Citation:
PMID:  15147659     Owner:  NLM     Status:  MEDLINE    
AIMS: To assess transthoracic echocardiography (TTE) using second harmonic imaging with Valsalva manoeuvre compared to transesophageal echocardiography (TEE) for the diagnosis of right to left cardiac and pulmonary shunts. METHODS AND RESULTS: One hundred and ten patients referred for TEE underwent TTE with bubble contrast. Bubbles in the left atrium within three cardiac cycles were considered diagnostic for a patent foramen ovale (PFO) and later as a pulmonary shunt. Greater than 20 bubbles in the left atrium was considered a large shunt and less than 20 a small shunt. TEE was performed immediately afterwards and read blinded to the TTE results. Pick-up rates were similar with 19 TEE positive (13 PFO) and 18 TTE positive (14 PFO) patients. There were five TEE positive/TTE negative cases who had significantly poorer TTE image quality score (2.7 +/- 0.8 vs 1.9 +/- 0.6, p < 0.05). There were six TEE negative/TTE positive cases, two cases requiring Valsalva manoeuvre to become positive. The Valsalva manoeuvre significantly increased the number of bubbles shunting (10 +/- 11 vs 20 +/- 19, p < 0.005). CONCLUSION: TTE with Valsalva manoeuvre is as good as TEE in diagnosing shunts. Valsalva manoeuvre increases the size of shunt. Both techniques produce false negative results.
N R A Clarke; J Timperley; A D Kelion; A P Banning
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Publication Detail:
Type:  Comparative Study; Journal Article    
Journal Detail:
Title:  European journal of echocardiography : the journal of the Working Group on Echocardiography of the European Society of Cardiology     Volume:  5     ISSN:  1525-2167     ISO Abbreviation:  Eur J Echocardiogr     Publication Date:  2004 Jun 
Date Detail:
Created Date:  2004-05-18     Completed Date:  2004-10-08     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  100890618     Medline TA:  Eur J Echocardiogr     Country:  England    
Other Details:
Languages:  eng     Pagination:  176-81     Citation Subset:  IM    
Department of Cardiology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK.
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MeSH Terms
Cardiac Output / physiology
Coronary Circulation / physiology
Coronary Thrombosis / ultrasonography
Echocardiography / methods*
Embolism, Paradoxical / diagnosis,  ultrasonography*
Heart Septal Defects, Atrial / diagnosis,  ultrasonography*
Middle Aged
Pulmonary Embolism / ultrasonography
Sodium Chloride / diagnostic use
Valsalva Maneuver*
Reg. No./Substance:
7647-14-5/Sodium Chloride

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

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