Wang Ping, Chen Sha-Sha, Li Ying, Zhang Xiao-Yong
Department of Ultrasound Medicine, The First People' Hospital of Xianyang City, Xianyang, China.
The First Affiliated Hospital of Xi'an Medical College, Xi'an, China.
Echocardiography. 2019 Apr;36(4):654-658. doi: 10.1111/echo.14289. Epub 2019 Feb 15.
To explore the value of cough maneuver (CM) in detecting right-to-left (RLS) during contrast transthoracic echocardiography (cTTE) and its mechanism.
We enrolled 196 patients with a high level of clinical suspicion of RLS underwent cTTE for RLS detection. Valsalva maneuver (VM) (blowing into a face mask connected to a sphygmomanometer at 40 mm Hg for 10 seconds) and CM were performed to provoke RLS, respectively. A comparison of the two provocative maneuvers in terms of the RLS-detection rate, the degree of RLS, the mobility of septum primum was done.
The detection rates of RLS for CM were significantly higher than that for VM (38.3% vs 32.1%), (P < 0.001). There was no significant difference between VM and CM in terms of detecting moderate- or severe-extent RLS (P > 0.05), however, CM was significantly better than VM in detecting mild-extent RLS (P = 0.004). CM caused a greater mobility of septum primum than VM (20.1 ± 0.2 mm vs 6.3 ± 0.1 mm), (P < 0.001).
Cough maneuver had a higher detection rate for RLS than VM during cTTE, maybe due to its greater mobility of septum primum than VM caused.
探讨咳嗽动作（CM）在对比剂经胸超声心动图（cTTE）检测右向左分流（RLS）中的价值及其机制。
我们纳入了196例临床高度怀疑存在RLS的患者，对其进行cTTE以检测RLS。分别进行Valsalva动作（VM）（对着连接到血压计的面罩吹气，保持40 mmHg 10秒）和CM以诱发RLS。比较两种诱发动作在RLS检测率、RLS程度、原发隔活动度方面的差异。
CM的RLS检测率显著高于VM（38.3%对32.1%），（P<0.001）。VM和CM在检测中度或重度RLS方面无显著差异（P>0.05），然而，CM在检测轻度RLS方面显著优于VM（P = 0.004）。CM引起的原发隔活动度大于VM（20.1±0.2 mm对6.3±0.1 mm），（P<0.001）。
在cTTE期间，咳嗽动作对RLS的检测率高于VM，可能是由于其引起的原发隔活动度大于VM所致。
