985 Feasibility of transcranial contrast-enhanced color-coded sonography for detection of intracardiac right to left shunt

2005 European Journal of Echocardiography  
Abstracts S 157 40 ywoman with mulliple neurological events was with ASA and R-L shunt through PFO during Valsalva. She was relerred for lranscalheler closure. 985 Feasibility of transcranial contrast-enhanced color-coded sonography for detection of intracerdiac right to le~ shunt M. Sorbo, M. Pietra. Padova, Italy Patenl loramen ovale (PFO) with righl to lell shunl (RLSh), has been suggesled as a polenlial source ol paradoxical embolism for ischemic stroke. Conlrasl malerialenhanced
more » ... geal echocardiography (c-TEE) is gold slandard lor diagnosis, but is semiinvasive and depends on the palienl's ability to swallow. Conlraslenhanced transcranial Doppler ultrasonography (c-TCD), has become an optional method for detecting a intracardiac RLSh and superior over c-TEE The absence of temporal windows can represent an indisputable limitation ol c-TCD (palienfs age after 60 years and the sex). Aim: Feasibility ol c-TCD as a screening method lor diagnosis ol inlracardiac right to lelt shunt in selected population. Methods: Between February 2004 and May 2005, 85 patients admitted with slroke or transient ischemic attack, were studied in our department ol Cardiology, with c-TCD, method never perlormed belore, for delection ol intracardiac righl to lell shunt. The mean age was 57,5 years (age range, 24-82 years), 47 lemale and ,38 male. All palients underwent a slandardized stroke diagnostic work-up. C-TCD examinalion was carried out using a phased-array transducer (Hewleu Packard Songs 5500; Philips Medical Systems). Conlrasl examinalion (glucose solulion (9 mL) and air (1 mL), agilaled between two 10-mL syringes) was made al righl bone window. The injeclion was performed during normal brealhing and during a Valsalva maneuver. The appearance ol air-embolism signals in the cerebral arteries within 7 seconds of the injection was considered positive lot intracardiac shunt (hyperinlense audible signals in 1 cerebral artery). Results: An optimal temporal acoustic window was found in 76 out ol 85 patients (89,4%), in 42 out of 47 female (89,3%) e in 31 out ol 38 male (81,5%). Forty-seven subjects were older than sixly (55%); an optimal window was lound in 37 (78°/,). The subjects younger than sixty were 38 (45%) and no one had unlavourable window (100%). The middle cerebral arlery was sampled in 60 oul ol 85 palienls (70%), anlerior cerebral arlery in 20 (23%), poslerior cerebral arlery in 26 (30%). More than one arlery was sampled in 26 oul of 85 patients (30%). Every examination look almost 10 minutes. Discussion: The leasibility ol e-TCD is high especially in sublecls younger than sixty. Slight difference were lound between female (more leasible) and male.The results of this sludy imply lhal c-TCD may be used as an allernalive tool Io detect cardiac righl-to-lefl shunt and may be used to complemenl c-TEE, because is feasible, last, and valid non-invasive bedside method.
doi:10.1016/s1525-2167(05)80592-x fatcat:jxtiivjmjrewvbgkwbuv6gsuly