Comparison of Different Methods of Valsalva Maneuver for Right-to-left Shunt Detection by Contrast-Enhanced Transcranial Doppler

Guo, Yuzhu; Gao, Yongsheng; Guo, Zhen‐Ni; Niu, Peng-Peng; Yang, Yi; Xing, Yingqi

doi:10.1016/j.ultrasmedbio.2015.12.020

Cited by 13 publications

(21 citation statements)

References 29 publications

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“…There are several different methods of performing the VM. A standard procedure of the VM is not available, and the m-VM provoked a much higher positive rate of RLS detection than c-VM [11]. Considering m-VM as an effective provocation method, we sought to determine whether coughing is as effective as m-VM instead of c-VM.…”

Section: Discussionmentioning

confidence: 99%

“…(b) The white arrow shows the Doppler flow velocity curve (down first and then up) (adapted from Guo et al . with permission [11]).…”

Section: Methodsmentioning

confidence: 99%

“…The cough maneuver was determined to be adequate if a leftward shift of the atrial septum was present on c-TTE imaging. For the m-VM, participants were coached to blow into the connecting tube of a sphygmomanometer at 40 mm Hg for a 10-s period, starting 5 s after the initiation of medium injection [7, 11]. After the RS test, patients were randomly assigned to either cough or to undergo the m-VM test first.…”

Section: Methodsmentioning

confidence: 99%

“…Unfortunately, the most recent International Consensus Meeting did not provide explicit instructions regarding the standard procedure for the VM [7]. In a recent study, authors reported that m-VM provoked a much higher positive rate of RLS detection than c-VM (hold expiration and release to transiently increase right arterial pressure), with higher detection rates observed in c-TCD [11]. …”

Section: Introductionmentioning

confidence: 99%

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Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

Wang

et al. 2017

PLoS ONE

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Contrast-enhanced transcranial Doppler (c-TCD) has been used to detect right-to-left shunts (RLS) because it is highly sensitive and cost-effective. The use of provocation maneuvers, such as physiologic maneuvers (e.g., coughing) and the Valsalva maneuver (VM) to transiently increase right atrial pressure and induce RLS increases the sensitivity of RLS detection. In this study, we sought to determine whether coughing is as effective as the VM in aiding the detection of RLS. We evaluated 162 subjects for RLS, using c-TCD under three different conditions: (i) resting state, (ii) coughing, and (iii) modified VM (m-VM), which involved blowing into a tube connected to a sphygmomanometer at 40 mmHg for 10 s. The positive rate of RLS detection with the m-VM was significantly higher than that with coughing. In addition, a difference between the two maneuvers was observed in terms of the degree of RLS seen. The m-VM should be widely used to detect RLS, because it is reliable, standardized, and cost-effective.

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Section: Discussionmentioning

confidence: 99%

“…(b) The white arrow shows the Doppler flow velocity curve (down first and then up) (adapted from Guo et al . with permission [11]).…”

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

Wang

et al. 2017

PLoS ONE

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“…The procedure was performed three times: the first time during normal breathing and then two times during a 10 s VM that started 5 s after the initiation of medium injection (11). The patient was trained to inhale deeply and hold back expiration for 10 s, and then to release it to perform the VM; this corresponds to 15 s after the beginning of the medium injection (12). The highest single count of the number of MBs was taken as the estimate of shunt degree for each patient during two executions of a VM.…”

Section: Methodsmentioning

confidence: 99%

Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study

et al. 2017

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Background The association between RLS and migraine is still debated. The aim of this study is to investigate the prevalence and grade of RLS in Chinese patients with migraine and to evaluate the relationship between RLS and migraine. Methods A multi-center case-control study of contrast-enhanced transcranial Doppler was conducted in 931 consecutive patients with migraine (240 of 931 had migraine with aura and 691 of 931 were in the migraine without aura group) and 282 were healthy adults. Clinical trial no. NCT02425696. Results The prevalence of RLS was 63.8% and 39.9% in the migraine with aura group (MA+) and migraine without aura group (MA-), respectively, significantly higher than that of the healthy group (29.4%, p < 0.001; p < 0.001). The positive rate of large RLS in the MA+ group and MA- group was 32.1% and 16.5%, respectively, significantly higher than healthy group (6.4%, p < 0.001; p < 0.001). There was no difference among groups in terms of positive rate of permanent RLS ( p = 0.704). Conclusion This multi-centre case-control study suggested that there is an association between RLS and migraine with and without aura, especially when the shunt is large.

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Contrast‐enhanced transcranial Doppler for the detection of right‐to‐left shunt: A new provocation method with a syringe‐modified Valsalva maneuver

Deng,

Luo,

Luo

et al. 2024

Brain and Behavior

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BackgroundContrast‐enhanced transcranial Doppler (cTCD) study has been established as one of the most common investigations for detecting right‐to‐left shunt (RLS). Although the conventional Valsalva maneuver (c‐VM) has been used to increase the sensitivity of cTCD for RLS, efforts are still needed to improve the detection rate further. We proposed a new provocation method with a syringe‐modified Valsalva maneuver (sm‐VM) during cTCD and compared the efficacy of this strategy with cTCD measured at resting and with the provocation of c‐VM.MethodsConsecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c‐VM and sm‐VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared.ResultsA total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm‐VM than those detected at resting state and with c‐VM (46.8% vs. 21.6% and 34.2%, all p < .05). Besides, cTCD detected with sm‐VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c‐VM (11.3% vs. 1.8% and 0%, all p < .05).ConclusionsCompared to cTCD detected at resting state and with c‐VM, cTCD with sm‐VM could further increase the positive detection rate of RLS.

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Comparison of Different Methods of Valsalva Maneuver for Right-to-left Shunt Detection by Contrast-Enhanced Transcranial Doppler

Cited by 13 publications

References 29 publications

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuver

Prevalence and extent of right-to-left shunt on contrast-enhanced transcranial Doppler in Chinese patients with migraine in a multicentre case-control study

Contrast‐enhanced transcranial Doppler for the detection of right‐to‐left shunt: A new provocation method with a syringe‐modified Valsalva maneuver

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