Shariat Abdolhamid, Yaghoubi Ehsan, Nemati Reza, Aghasadeghi Kamran, Borhani Haghighi Afshin
Neuroscience Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
Acta Neurol Taiwan. 2011 Sep;20(3):182-7.
To evaluate a technique for contrast agent preparation as mixing the patients' blood with agitated saline and to compare it with agitated saline alone in diagnosis of cardiac right-to-left shunt in regard to their sensitivity, time window, and distribution of artificially induced microembolic signals.
Fifty-two patients with stroke who had Transesophageal echocardiography proven right-to-left shunt underwent contrast-transcranial Doppler sonography with injection of agitated (i) 9 ml saline with 1 ml air with Valsalva maneuver, (ii) 9 ml saline with 1 ml air without Valsalva maneuver, (iii) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air with Valsalva maneuver, and (iv) 8 ml saline, 1 ml of the patient's fresh blood and 1 ml air without Valsalva maneuver.
The sensitivity of the bilateral middle cerebral artery monitoring in diagnosis of right-to-left shunt was 94.2%, 71.2%, 96.2% and 76.9% for agitated saline with Valsalva maneuver, agitated saline without Valsalva maneuver, agitated saline and blood with Valsalva maneuver, and agitated saline and blood without Valsalva maneuver methods, respectively. Severe right-to-left shunt was detected in 100% of patients when agitated saline and blood with Valsalva maneuver was used. Application of Valsalva maneuver resulted in detection of more right-to-left shunt (P = 0.002).
Agitated saline mixed with blood with Valsalva maneuver is a sensitive method to detect right-to- left shunt, especially in the case of severe shunt. Mixing agitated saline with blood may increase the sensitivity of the test.
评估一种将患者血液与振荡生理盐水混合的造影剂制备技术，并在诊断心脏右向左分流方面，将其与单纯振荡生理盐水在敏感性、时间窗和人工诱导微栓子信号分布方面进行比较。
52例经食管超声心动图证实存在右向左分流的中风患者接受了对比经颅多普勒超声检查，分别注射：（i）9毫升生理盐水加1毫升空气并进行瓦尔萨尔瓦动作；（ii）9毫升生理盐水加1毫升空气但不进行瓦尔萨尔瓦动作；（iii）8毫升生理盐水、1毫升患者新鲜血液加1毫升空气并进行瓦尔萨尔瓦动作；（iv）8毫升生理盐水、1毫升患者新鲜血液加1毫升空气但不进行瓦尔萨尔瓦动作。
对于振荡生理盐水并进行瓦尔萨尔瓦动作、振荡生理盐水不进行瓦尔萨尔瓦动作、振荡生理盐水与血液混合并进行瓦尔萨尔瓦动作以及振荡生理盐水与血液混合不进行瓦尔萨尔瓦动作这几种方法，双侧大脑中动脉监测诊断右向左分流的敏感性分别为94.2%、71.2%、96.2%和76.9%。当使用振荡生理盐水与血液混合并进行瓦尔萨尔瓦动作时，100%的患者检测到严重右向左分流。应用瓦尔萨尔瓦动作可检测到更多右向左分流（P = 0.002）。
振荡生理盐水与血液混合并进行瓦尔萨尔瓦动作是检测右向左分流的敏感方法，尤其是在严重分流的情况下。将振荡生理盐水与血液混合可能会提高检测的敏感性。
