Department of Cardiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan.
J Cardiol. 2009 Dec;54(3):494-8. doi: 10.1016/j.jjcc.2009.03.006. Epub 2009 Apr 29.
We report two cases in which contrast echocardiography was useful for detecting right-to-left shunt. In case 1, a 53-year-old man was admitted to our hospital after being diagnosed with acute heart failure. Even after improvement of the heart failure, hypoxemia remained. Contrast echocardiography was performed. When contrast medium was injected into the left antecubital vein, it directly drained into the left atrium. When contrast medium was injected into the right antecubital vein, it drained into the right atrium not the left atrium. These findings proved the existence of a right-to-left shunt. In case 2, a 68-year-old man felt dyspnea on mild effort, especially when sitting in an anteflexing posture. In room air, his SpO2 was 95% when sitting in a resting posture and 79% when in an anteflexing sitting posture. Contrast echocardiography was performed. A patent foramen ovale (PFO) was proved using the Valsalva maneuver, and the contrast medium drained from right atrium into the left atrium via the PFO. He underwent patch closure of the PFO, and his symptoms disappeared. Contrast echocardiography should be performed for the diagnosis of chronic hypoxemia for which causes are not detected with routine clinical examinations, in order to confirm right-to-left shunt.
我们报告了两例通过对比超声心动图检测到右向左分流的病例。病例 1 中，一名 53 岁男性因急性心力衰竭入院。即使心力衰竭得到改善，仍存在低氧血症。进行了对比超声心动图检查。当将造影剂注入左肘前静脉时，造影剂直接流入左心房。当将造影剂注入右肘前静脉时，造影剂流入右心房而不是左心房。这些发现证明存在右向左分流。病例 2 中，一名 68 岁男性在轻度用力时感到呼吸困难，尤其是在前倾坐姿时。在室温空气中，他在休息坐姿时的 SpO2 为 95%，在前倾坐姿时为 79%。进行了对比超声心动图检查。使用瓦尔萨尔瓦动作证明卵圆孔未闭（PFO），造影剂从右心房经 PFO 流入左心房。他接受了 PFO 修补术，症状消失。对于常规临床检查无法发现病因的慢性低氧血症，应进行对比超声心动图检查以确认右向左分流。
