This paper is only available as a PDF. To read, Please Download here.
Abstract
Transesophageal contrast echocardiography is an effective but semiinvasive technique
for the detection of interatrial right-to-left shunts. Transcranial Doppler ultrasound
is an alternative noninvasive method, but may be limited by falsepositive diagnoses
due to intrapulmonary shunting. This study examined the accuracy of transcranial Doppler
for the detection of shunt lesions. Transcranial Doppler of the right middle cerebral
artery was performed simultaneously with transesophageal and transthoracic contrast
echocardiography in 32 patients using agitated saline contrast during normal respiration
and Valsalva. Transesophageal contrast echocardiography diagnosed an interatrial right-to-left
shunt in 13 patients and intrapulmonary shunting in 6 patients. Transcranial Doppler
identified all 13 interatrial right-to-left shunts and an intrapulmonary shunt in
3 of 6 patients. Absence of a shunt was confirmed by transcranial Doppler in 12 of
12 patients. Transcranial Doppler had a sensitivity of 100% (13 of 13), specificity
of 100% (18 of 18) and accuracy of 100% (31 of 31) for prediction of an interatrial
right-to-left shunt by transesophageal contrast echocardiography. In comparison, transthoracic
contrast echocardiography had a sensitivity of 54% (7 of 13), specificity of 94% (17
of 18) and accuracy of 77% (24 of 31). Thus, transcranial Doppler is highly accurate
for detection of an interatrial right-to-left shunt and not compromised by physiologic
intrapulmonary shunts, whereas transthoracic contrast echocardiography lacks sensitivity.
Transcranial Doppler may be useful as an alternative to transesophageal study, where
the primary indication for transesophageal echocardiography is exclusion of an interatrial
right-to-left shunt.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to American Journal of CardiologyAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of patent foramen ovale in patients with stroke.N Engl J Med. 1988; 318: 1148-1152
- Patent foramen ovale in young stroke patients.Lancet. 1988; 2: 11-12
- Clinically silent atrial septal defects with evidence for cerebral embolization.Ann Intern Med. 1986; 105: 695-697
- Cerebral emboli of paradoxical origin.Ann Neurol. 1983; 13: 314-319
- Paradoxical embolism: clinical presentation, diagnostic strategies, and therapeutic options.Am Heart J. 1986; 112: 141-145
- Peripheral venous contrast echocardiography.Am J Cardiol. 1977; 39: 202-212
- Contrast echocardiographic visualization of cough-induced right to left shunt through a patent foramen ovale.J Am Coll Cardiol. 1984; 4: 587-594
- Superiority of transesophageal echocardiography in detecting cardiac source of embolism in patients with cerebral ischemia of uncertain etiology.J Am Coll Cardiol. 1991; 1: 66-72
- Detection of paradoxical cerebral echo contrast embolization by transcranial Doppler ultrasound.Stroke. 1991; 22: 740-745
- Diagnosis of patent foramen ovale by transesophageal contrast echocardiography (abstr).Circulation. 1988; 78: II-441
- Transesophageal echocardiography: technique, anatomic correlations, implementation and clinical applications.in: 3rd ed. Mayo Clin Proc. 63. 1988: 649-680
- Positive contrast echocardiography in patients with patent foramen ovale and normal right heart hemodynamics.Am J Cardiol. 1982; 49: 1806-1809
- Detection of air embolism by transesophageal echocardiography.Anesthesiology. 1983; 58: 124-129
- Detection and evaluation of intrapulmonary vascular shunt with “contrast Doppler” transesophageal echocardiography.J Am Soc Echo. 1991; 4: 79-83
- Detection of middle cerebral artery emboli during carotid endarterectomy using transcranial Doppler ultrasonography.Stroke. 1990; 21: 415-423
- Contrast agents for myocardial perfusion studies: mechanisms, state of the art and future prospects.in: Iliceto S Rizzon P Roelandt J Ultrasound in Coronary Artery Disease. Kluwer Academic Publishers, Amsterdam1991: 351-365
Article info
Publication history
Accepted:
August 3,
1991
Received in revised form:
August 1,
1991
Received:
April 22,
1991
Identification
Copyright
© 1991 Published by Elsevier Inc.
