Albert A, Müller H R, Hetzel A
Department of Neurology, University of Freiburg, Germany.
J Neuroimaging. 1997 Jul;7(3):159-63. doi: 10.1111/jon199773159.
Transcranial Doppler sonography (TCD) is a simple method to detect a right-to-left cardiac shunt, although standardized procedures do not exist. In this study 69 patients were tested according to predetermined criteria and procedures (cluster of > 10 microbubbles, duration between injection in the cubital vein and detection in the middle cerebral artery [MCA] < or = 10 sec). Agitated saline solution was compared to oxypolygelatine, a plasma volume expander, as contrast media. Valsalva's maneuver and coughing were used to provoke right-to-left cardiac shunting, detected by TCD, transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE). Oxypolygelatine caused a significantly higher number of microbubbles in the right atrium and MCA than did the saline solution, leading to a greater diagnostic reliability of TCD (paired t test, p < 0.001). Coughing did not provoke right-to-left cardiac shunts (x2 analysis, p < 0.001). The technique used for carrying out Valsalva's maneuver was important for the detection of right-to-left cardiac shunts. Twenty-five right-to-left shunts were diagnosed with TCD and 18 with TTE (36 vs 26%; x2 analysis, p = 0.1). The findings indicate that TCD when properly done is highly sensitive and specific for the diagnosis of right-to-left cardiac shunts.
经颅多普勒超声检查（TCD）是检测心脏右向左分流的一种简单方法，尽管目前尚无标准化程序。在本研究中，根据预先确定的标准和程序（>10个微泡簇，肘静脉注射至大脑中动脉[MCA]检测的持续时间≤10秒）对69例患者进行了检测。将搅拌生理盐水溶液与血浆容量扩充剂氧化聚明胶作为对比剂进行比较。采用瓦尔萨尔瓦动作和咳嗽来诱发心脏右向左分流，通过TCD、经胸超声心动图（TTE）和经食管超声心动图（TEE）进行检测。与生理盐水溶液相比，氧化聚明胶在右心房和MCA中产生的微泡数量明显更多，从而提高了TCD的诊断可靠性（配对t检验，p<0.001）。咳嗽未诱发心脏右向左分流（χ²分析，p<0.001）。进行瓦尔萨尔瓦动作的技术对检测心脏右向左分流很重要。TCD诊断出25例心脏右向左分流，TTE诊断出18例（36%对26%；χ²分析，p=0.1）。研究结果表明，操作得当的TCD对心脏右向左分流的诊断具有高度敏感性和特异性。
