Hajduczok Z D, Winniford M D, Kerber R E
Department of Internal Medicine, University of Iowa.
J Am Soc Echocardiogr. 1992 Sep-Oct;5(5):475-80. doi: 10.1016/s0894-7317(14)80038-2.
Ultrasound contrast techniques are used widely as a screening test for intracardiac shunt. We performed a retrospective analysis of contrast echocardiograms in 29 consecutive patients with atrial septal defect (excluding Eisenmenger's) proved by cardiac catheterization. A positive (right-to-left atrial) ultrasound contrast effect was seen in 25 patients in whom catheterization pulmonary-to-systemic flow rate (Qp/Qs) was 2.2 +/- 0.9 (SD). Four patients had false-negative contrast echocardiography results; their Qp/Qs was 2.9 +/- 0.4 (p = 0.07). The percent left-to-right shunt was higher in the group with false-negative contrast echocardiographic results (65% +/- 4% vs 47% +/- 21%) (p = 0.05). Shunts with Qp/Qs < or = 2.0 had a sensitivity of 100%, whereas those with Qp/Qs > or = 2.1 had a sensitivity of 73%. In the four false-negative contrast echocardiographic results, three had findings of an atrial septal defect by pulsed Doppler, color Doppler, or both. Thus the presence of a large left-to-right shunt may decrease the sensitivity of the ultrasound contrast technique for the detection of an atrial septal defect. Contrast ultrasonography should be used in conjunction with Doppler and two-dimensional echocardiography criteria for diagnosis of atrial septal defect.
超声造影技术被广泛用作心内分流的筛查试验。我们对29例经心导管检查证实为房间隔缺损（不包括艾森曼格综合征）的连续患者的超声心动图造影结果进行了回顾性分析。25例患者出现阳性（右向左心房）超声造影效果，其心导管检查测得的肺循环与体循环血流量之比（Qp/Qs）为2.2±0.9（标准差）。4例患者超声心动图造影结果为假阴性，其Qp/Qs为2.9±0.4（p = 0.07）。假阴性超声心动图造影结果组的左向右分流百分比更高（65%±4% 对 47%±21%）（p = 0.05）。Qp/Qs≤2.0的分流敏感性为100%，而Qp/Qs≥2.1的分流敏感性为73%。在4例假阴性超声心动图造影结果中，3例通过脉冲多普勒、彩色多普勒或两者检查发现有房间隔缺损。因此，存在大量左向右分流可能会降低超声造影技术检测房间隔缺损的敏感性。超声造影检查应与多普勒及二维超声心动图标准联合使用，以诊断房间隔缺损。
