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Titolo:
Contrast transcranial Doppler ultrasound in the detection of right-to-leftshunts - Time window and threshold in microbubble numbers
Autore:
Droste, DW; Silling, K; Stypmann, J; Grude, M; Kemeny, V; Wichter, T; Kuhne, K; Ringelstein, EB;
Indirizzi:
Univ Munster, Dept Neurol, D-4400 Munster, Germany Univ Munster Munster Germany D-4400 Dept Neurol, D-4400 Munster, Germany Univ Munster, Dept Cardiol & Angiol, D-4400 Munster, Germany Univ MunsterMunster Germany D-4400 ol & Angiol, D-4400 Munster, Germany Univ Munster, Inst Arteriosclerosis Res, D-4400 Munster, Germany Univ Munster Munster Germany D-4400 lerosis Res, D-4400 Munster, Germany
Titolo Testata:
STROKE
fascicolo: 7, volume: 31, anno: 2000,
pagine: 1640 - 1645
SICI:
0039-2499(200007)31:7<1640:CTDUIT>2.0.ZU;2-Y
Fonte:
ISI
Lingua:
ENG
Soggetto:
PATENT FORAMEN OVALE; TRANSESOPHAGEAL ECHOCARDIOGRAPHY; STROKE PATIENTS; PARADOXICAL EMBOLISM; VALSALVA MANEUVER; SURGICAL CLOSURE; SONOGRAPHY; ULTRASONOGRAPHY; AGENTS; TCD;
Keywords:
cerebral embolism; cerebrovascular disorders; foramen ovale, patent; ultrasonography;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
33
Recensione:
Indirizzi per estratti:
Indirizzo: Droste, DW WWU Munster, Neurol Klin & Poliklin, Albert Schweitzer Str 33, D-48129 Munster, Germany WWU Munster Albert Schweitzer Str 33 Munster Germany D-48129 y
Citazione:
D.W. Droste et al., "Contrast transcranial Doppler ultrasound in the detection of right-to-leftshunts - Time window and threshold in microbubble numbers", STROKE, 31(7), 2000, pp. 1640-1645

Abstract

Background and Purpose-Cardiac right-to-left shunts can be identified by transesophageal. echocardiography (TEE) and by transcranial Doppler ultrasound (TCD) with the use of contrast agents and a Varsalva maneuver (VM) as provocation procedure. Currently, data on the appropriate timing of the VM, the use of a diagnostic time window, and a threshold in contrast agent microbubbles detected are insufficient. Methods-Fifty-eight patients were investigated by both TEE and bilateral TCD of the middle cerebral artery. The following protocol with injections of10 mt of the commercial galactose-based contrast agent Echovist was applied in a randomized way: (1) no VM, (2) VM for 5 seconds starting 2 seconds after the beginning of contrast injection, (3) VM for 5 seconds starting 5 seconds after the beginning of contrast injection, (4) VM for 5 seconds starting 8 seconds after the beginning of contrast injection, and (5) repetitive short VMs in between 2 and 13 seconds after the beginning of contrast injection. In addition to the single tests, we also tested the sensitivity andspecificity of combined results of the tests with VM. Results-In 21 patients, a right-to-left shunt was demonstrated by TEE and contrast TCD (shunt positive). Twenty-one patients were negative in both investigations, no patient was positive on TEE and negative on TCD, and 16 patients were only positive on at least I TCD investigation but negative during TEE. Test 3 was the most appropriate test when combined with the resultsof 1 of the other tests with VM. The highest sensitivities were achieved with a diagnostic time window of 40 seconds and when the presence of a single microbubble was sufficient for the diagnosis of a shunt. Conclusions-TCD performed twice with 2 provocation maneuvers with Echovistis a sensitive method to identify TEE-proven cardiac right-to-left shunts. The VM should be performed for 5 seconds starting at 5 seconds after the beginning of contrast injection.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 09/04/20 alle ore 06:54:54