Maillet Alexandre, Pavero Antoine, Salaun Pierre, Pibourdin Alexis, Skopinski Sophie, Thambo Jean-Benoit, Sibon Igor, Constans Joël, Boulon Carine
1 Service de Médecine Vasculaire, Hôpital St André, Bordeaux, France.
2 Service des Maladies cardio-vasculaires congénitales, Hôpital Cardiologique, Pessac, France.
Angiology. 2018 Jan;69(1):79-82. doi: 10.1177/0003319717712356. Epub 2017 Jun 6.
We compared transcranial Doppler (TCD) with transesophageal echocardiography (TEE) and transthoracic echocardiography (TTE) for the detection of right to left communication (RLC) in the heart. All patients explored from 2013 to 2016 in a vascular medicine unit to detect RLC by TCD were included. Right to left communication was detected by TCD monitoring for microembolic signals after intravenous injection of agitated 5% glucose and air. One hundred one patients were explored for RLC by TCD, 64 by TEE (not possible in 10, bubble injection in 51), and 93 by TTE because of unexplained stroke or arterial thrombosis (51 males, 50 females, age 51.0 ± 15.8 years) (bubble injection in 35). Fifty-three patients were positive after TCD (TEE: 4 negative, TTE: 7 negative). Of the negative patients after TCD, none was positive for TEE and 1 was positive for TTE with no evidence of patent foramen ovale. Transcranial Doppler was sensitive to detect RLC, even in patients with negative TTE or TTE. A negative TEE did not exclude RLC demonstrated by TCD. Transcranial Doppler might be proposed as first line to detect RLC.
我们比较了经颅多普勒（TCD）、经食管超声心动图（TEE）和经胸超声心动图（TTE）在检测心脏右向左分流（RLC）方面的效果。纳入了2013年至2016年在血管医学科通过TCD检测RLC的所有患者。通过静脉注射振荡的5%葡萄糖和空气后，利用TCD监测微栓子信号来检测右向左分流。101例患者通过TCD检测RLC，64例通过TEE检测（10例无法进行，51例进行了气泡注射），93例因不明原因的中风或动脉血栓形成通过TTE检测（51例男性，50例女性，年龄51.0±15.8岁）（35例进行了气泡注射）。TCD检测后53例患者呈阳性（TEE：4例阴性，TTE：7例阴性）。TCD检测为阴性的患者中，TEE检测均为阴性，TTE检测有1例阳性，但无卵圆孔未闭的证据。经颅多普勒对检测RLC很敏感，即使在TTE或TEE检测为阴性的患者中也是如此。TEE检测阴性并不能排除TCD显示的RLC。经颅多普勒可作为检测RLC的一线方法。
