Gin K G, Huckell V F, Pollick C
Department of Medicine, Vancouver General Hospital, British Columbia.
J Am Coll Cardiol. 1993 Dec;22(7):1994-2000. doi: 10.1016/0735-1097(93)90789-4.
We postulated that femoral vein delivery of contrast medium because of streaming, might enhance precordial echocardiographic detection of patent foramen ovale.
Although precordial contrast echocardiography is widely used to diagnose patent foramen ovale, this method is limited by poor sensitivity. Previous investigators have demonstrated enhanced detection of atrial defects by the dye-dilution technique after delivery of contrast medium into the inferior rather than the superior vena cava.
Transthoracic contrast examinations were performed in a randomly selected group of 70 patients (without previous history of cerebral or systemic embolus) undergoing cardiac catheterization. Paired contrast agent injections (10 ml dextrose in water/0.25 ml air) were administered from an upper extremity vein and femoral vein in each patient during spontaneous respiration, cough and Valsalva maneuvers. Studies were interpreted by an experienced echocardiographer unaware of the sequence and site of injections. Positive studies were semiquantitatively graded from +1 (minimal left ventricular opacification) to +4 (intense left ventricular opacification). Catheterization and echocardiographic assessment of patent foramen ovale were compared in 21 subjects.
Patent foramen ovale was detected significantly more often during femoral vein versus upper extremity contrast delivery (23 of 70 patients [prevalence 33%] vs. 9 of 70 patients [prevalence 13%], p < 0.001). The intensity of left ventricular opacification was also greater during femoral vein contrast injection. Precordial echocardiography combined with femoral contrast delivery was significantly more sensitive than cardiac catheterization for assessment of patent foramen ovale (8 of 21 patients vs. 2 of 21 patients, p < 0.05).
Femoral vein contrast delivery significantly enhances the ability of precordial contrast echocardiography to diagnose patent foramen ovale. Physiologic patency of the foramen ovale is more common (prevalence 33%) than previously documented.
我们推测，由于血流状态，经股静脉注射造影剂可能会提高经胸超声心动图对卵圆孔未闭的检测能力。
尽管经胸对比超声心动图广泛用于诊断卵圆孔未闭，但该方法敏感性较差。先前的研究人员已证明，将造影剂注入下腔静脉而非上腔静脉后，通过染料稀释技术可提高心房缺损的检测率。
对70例接受心导管检查（无前脑或全身性栓塞病史）的患者进行随机分组，进行经胸对比检查。在每位患者自主呼吸、咳嗽和瓦尔萨尔瓦动作期间，从上肢静脉和股静脉分别注射配对的造影剂（10 ml葡萄糖溶液/0.25 ml空气）。由一位不了解注射顺序和部位的经验丰富的超声心动图医生对研究结果进行解读。阳性研究结果从+1（左心室轻度显影）到+4（左心室强烈显影）进行半定量分级。对21名受试者的卵圆孔未闭进行心导管检查和超声心动图评估并比较。
与经上肢静脉注射造影剂相比，经股静脉注射造影剂时，卵圆孔未闭的检出率显著更高（70例患者中有23例[患病率33%]，而70例患者中有9例[患病率13%]，p<0.001）。股静脉注射造影剂时，左心室显影强度也更大。经胸超声心动图结合经股静脉注射造影剂评估卵圆孔未闭的敏感性显著高于心导管检查（21例患者中有8例，而21例患者中有2例，p<0.05）。
经股静脉注射造影剂显著提高了经胸对比超声心动图诊断卵圆孔未闭的能力。卵圆孔的生理性开放比之前记录的更为常见（患病率33%）。
