Konstantinides S, Kasper W, Geibel A, Hofmann T, Köster W, Just H
Innere Medizin III, Universitätsklinik Freiburg, Germany.
Am Heart J. 1993 Oct;126(4):909-17. doi: 10.1016/0002-8703(93)90706-f.
The occurrence of a right atrial negative contrast effect as an indicator of left-to-right shunt was studied in 101 patients with atrial septal defect by peripheral venous contrast injection during transthoracic and transesophageal echocardiography. Confirmation of the diagnosis was provided by cardiac catheterization or by autopsy in 72 (72%) patients. The defect could be visualized directly in 57 (57%) patients during the transthoracic and in 93 (93%) during the transesophageal examination (p < 0.001). A negative right atrial echo contrast effect was observed in 53 of 92 (58%) patients from the transthoracic and in 86 of 92 (93%) patients from the transesophageal approach (p < 0.001). Among these were seven (7%) patients with an aneurysmal interatrial septum but no directly visible defect during conventional transesophageal imaging. Appearance of contrast in the left atrium indicating right-to-left shunting was seen in 70 of 92 (76%) patients from the transthoracic and in 91 of 92 (99%) patients from the transesophageal approach (p < 0.001). Contrast injection during transesophageal imaging also helped identify additional malformations in 12 (12%) patients. Thus transesophageal echocardiography with echo contrast injection is a very reliable diagnostic method in patients with suspected atrial septal defect.
在101例房间隔缺损患者中，通过经胸和经食管超声心动图经外周静脉注射造影剂，研究了右心房负性造影剂效应作为左向右分流指标的情况。72例（72%）患者通过心导管检查或尸检确诊。在经胸检查中，57例（57%）患者可直接观察到缺损，经食管检查中93例（93%）患者可观察到缺损（p<0.001）。经胸检查的92例患者中有53例（58%）观察到右心房回声负性造影剂效应，经食管检查的92例患者中有86例（93%）观察到（p<0.001）。其中有7例（7%）患者房间隔呈瘤样改变，但在传统经食管成像中未发现直接可见的缺损。经胸检查的92例患者中有70例（76%）、经食管检查的92例患者中有91例（99%）观察到左心房出现造影剂提示右向左分流（p<0.001）。经食管成像时注射造影剂还帮助12例（12%）患者发现了其他畸形。因此，经食管超声心动图注射造影剂对疑似房间隔缺损患者是一种非常可靠的诊断方法。
