de Belder M A, Tourikis L, Griffith M, Leech G, Camm A J
Department of Cardiological Sciences, St. George's Hospital Medical School, Tooting, London, United Kingdom.
Am Heart J. 1992 Dec;124(6):1545-50. doi: 10.1016/0002-8703(92)90070-c.
The detection of shunts at the atrial level is important, and a reliable means of diagnosis is required. Precordial contrast echocardiography is usually performed to detect such shunts. To investigate the advantages of transesophageal echocardiographic techniques, we studied 167 consecutive patients with both precordial and transesophageal echocardiography, using two-dimensional imaging with contrast techniques (with and without a Valsalva maneuver) and color flow mapping. A patent foramen ovale was diagnosed in 31 patients, an atrial septal defect in 11 (7 with bidirectional shunts), and a pulmonary arteriovenous fistula in 3 patients. All right-to-left shunts were detected with transesophageal contrast echocardiography. With these results used as the gold standard, the sensitivity of combined precordial techniques was 37% and that of transesophageal color flow mapping 46%. All left-to-right shunts were detected by transesophageal color flow mapping. With these results used as the gold standard, the sensitivities of both precordial color flow mapping and a transesophageal negative right atrial contrast study were 27%. We conclude that transesophageal contrast echocardiography is the echocardiographic method of choice for the detection of a right-to-left shunt at the atrial level, which cannot be excluded by negative results on precordial study or on transesophageal color flow map study. A left-to-right shunt at this level is best detected by transesophageal color flow mapping.
心房水平分流的检测很重要，需要一种可靠的诊断方法。通常采用心前区对比超声心动图来检测此类分流。为了研究经食管超声心动图技术的优势，我们对167例连续患者同时进行了心前区和经食管超声心动图检查，采用二维成像及对比技术（包括瓦尔萨尔瓦动作时和非瓦尔萨尔瓦动作时）以及彩色血流图。诊断出31例卵圆孔未闭、11例房间隔缺损（7例存在双向分流）和3例肺动静脉瘘。所有右向左分流均经食管对比超声心动图检测到。以这些结果作为金标准，联合心前区技术的敏感性为37%，经食管彩色血流图的敏感性为46%。所有左向右分流均经食管彩色血流图检测到。以这些结果作为金标准，心前区彩色血流图和经食管右心房阴性对比研究的敏感性均为27%。我们得出结论，经食管对比超声心动图是检测心房水平右向左分流的首选超声心动图方法，心前区检查或经食管彩色血流图检查阴性结果不能排除该分流。此水平的左向右分流最好经食管彩色血流图检测。
