Low sensitivity of the echocardiograph compared with contrast transcranial Doppler in right-to-left shunt

Martínez‐Sánchez, P.; Medina-Báez, Josmarlin; Lara‐Lara, Manuel; Oliva-Navarro, J.; Cazorla-García, R.; Ruíz-Ares, Gerardo; Martínez-Martínez, Marta; Fuentes, Blanca; Díez‐Tejedor, Exuperio

doi:10.1016/j.nrleng.2012.03.006

Cited by 10 publications

(30 citation statements)

References 20 publications

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“…Several previous studies demonstrate the low sensitivity of TTE compared with TEE. 20 , 21 A meta-analysis also suggested that when contrast TEE is used as the gold standard, routine c-TTE diagnoses intracardiac RLS with a sensitivity of 46% and specificity of 99%, 22 which was similar to that reported in our study. Another meta-analysis revealed that TCD yielded a weighted mean sensitivity and specificity for were 97% and 93%, respectively.…”

Section: Discussionsupporting

confidence: 88%

A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver

et al. 2015

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Patent foramen ovale (PFO) is a remnant of the fetal circulation exist in 20% of the general population. The purpose of our study was to compare of transthoracic echocardiography (TTE) and contrast-transcranial Doppler sonography (c-TCD) in the diagnosis and quantification of PFO with or without the Valsalva maneuver (VM).We studied 106 patients with a high clinical suspicion for PFO prospectively. Simultaneous c-TCD and TTE were conducted using agitated saline solution to detect right to left shunt (RLS). To classify RLS, mainly PFO, we applied a 4-level visual classification for c-TCD test: no occurrence of micro-embolic signals; grade I, 1 to 10 signals; grade II, 10 to 30 signals but not curtain; and grade III, curtain pattern. We used the number of micro-bubbles appeared in left atrium per frame image to define classification for TTE test: no occurrence of micro-bubbles; grade I, 1 to 10 micro-bubbles; grade II, 10 to 30 micro-bubbles; and grade III, more than 30 micro-bubbles or left atrium nearly filled with micro-bubbles or left atrial opacity. Statistical analyses were performed using SPSS Version 18.0.RLS was detected in 36.0% in c-TCD test and in 46% in TTE test at rest (P = 0.158). And during the VM, RLS was detected in 99.0% in c-TCD test and in 83.0% in TTE test (P < 0.001). Compared with the positive results of c-TCD and TTE at rest, the positive results of them with VM is more higher, respectively (all P < 0.001). The VM obviously increased the number of micro-bubbles shunting.Both c-TCD and TTE should used as initial screening tool for PFO. VM increases the size of shunt. VM resulted in detection of more RLS both in c-TCD and TTE tests.

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Section: Discussionsupporting

confidence: 88%

A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver

et al. 2015

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“…Despite the fact that the patient's ischemic stroke did not arise from the right atrial thrombi, we need to keep in mind that paradoxical emboli are not uncommon causes of ischemic stroke in the presence of right-to-left shunts [9]. TEE may not able to detect all the right-to left shunts, given the relatively high false negative rate of TEE [10]. Transcranial Doppler sonography (TCD) may be performed to further detect any right-to-left shunt missed by TEE due to the smaller size [11].…”

Section: Discussionmentioning

confidence: 96%

A Long Right Atrial Thrombus Intermittently Prolapsing into Right Ventricle in a Patient with Recurrent Ischemic Stroke: An Image Report

Liu¹,

Malik²,

Gammie³

et al. 2014

CRCM

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A 39-year-old male was admitted for recurrent ischemic strokes. TEE was performed to detect the potential intra-cardiac thrombi and right-to-left shunts. A large hypermobile, echodense, irregular mass was found in the right atrium, which looked like a cluster of grapes. The motion of the components of the mass was synchronized, prolapsing into right ventricle in an octopus-like fashion during diastole. There was no evidence for PFO or other intra-cardiac shunts by color flow Doppler. The patient was referred to surgery and a continuous 30 cm long thrombus spanning from the inferior vena cava to the right ventricle was discovered.

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“…However, compared with TEE and TTE, contrast transcranial Doppler (c-TCD) (Alexandrov et al 2012; Van et al 2010) has high sensitivity in detecting cardiac and non-cardiac RLS. The advantages of c-TCD may be caused by the presence of extra-cardiac RLS (Alexandrov et al 2012;Mart ınez-S anchez et al 2012). Moreover, additional advantages include its low cost, tolerability (Tsivgoulis et al 2011) and ability to detect microbubbles (MBs) as emboli pass intra-cranial arteries in real time (Alexandrov et al 2012), which enhances RLS during the Valsalva maneuver (VM), which can be standardized by observing the decrease in cerebral blood flow velocity (Jauss and Zanette 2000).…”

Section: Introductionmentioning

confidence: 99%

Body Positions in the Diagnosis of Right-to-Left Shunt by Contrast Transcranial Doppler

Han

Xing

Yang

et al. 2015

Ultrasound in Medicine & Biology

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Low sensitivity of the echocardiograph compared with contrast transcranial Doppler in right-to-left shunt

Cited by 10 publications

References 20 publications

A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver

A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver

A Long Right Atrial Thrombus Intermittently Prolapsing into Right Ventricle in a Patient with Recurrent Ischemic Stroke: An Image Report

Body Positions in the Diagnosis of Right-to-Left Shunt by Contrast Transcranial Doppler

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