不同状态时右心声学造影检测卵圆孔未闭右向左分流检出率的比较
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摘要
目的比较平静呼吸、valsalva动作及咳嗽动作在经胸超声心动图右心声学造影(c TTE)检测卵圆孔未闭(PFO)右向左分流的检出率。方法对396例临床需排除矛盾性栓塞患者行cTTE检查,以检测过程中左房室腔出现明确造影剂微泡为标准诊断右向左分流;以1~10个微泡/帧为少量分流,11~30个微泡/帧为中量分流,>30个微泡/帧为大量分流。比较平静呼吸、valsalva动作及咳嗽动作在右向左分流检出的差异并分析其原因。结果cTTE共检出PFO右向左分流119例,包括28例少量分流,60例中量分流和31例大量分类。Valsalva动作和咳嗽在检出中量及大量分流上没有显著性区别,但对少量分流的检出率显著不同(P<0.05)。咳嗽对于少量分流的检出率更高。结论咳嗽对少量分流的检出率高于valsalva动作。
AIM This study compared the diagnosis values of normal respiration,Valsalva maneuver,and deep cough in right heart contrast transthoracic echocardiography( cTTE) for right to left shunt in patent foramen ovale( PFO). METHODS A total of 396 patients requiring diagnostic exclusion of paradoxical embolism were conducted cTTE. Patients with microbubbles appearing in the left heart were diagnosed as right to left shunt: 1 to 10 microbubbles/frame were classed mild shunt; 11 to 30 microbubbles/frame were classed moderate shunt; > 30 microbubbles/frame were classed severe shunt. The present investigation compared normal respiration,standard Valsalva maneuver,and deep cough in the diagnosis of right to left shunt and explored potential mechanisms. RESULTS 119 cases of PFO with right to left shunt were detected using cTTE,including 28 cases of mild shunt,60 cases of moderate shunt,and 31 cases of severe shunt. There was no difference between standard valsalva maneover and deep cough in detecting moderate and severe shunt. However,there was a significant difference between standard valsalva maneover and deep cough in detecting mild shunt. Deep cough detected more cases than standard valsalva maneover( P < 0. 05). CONCLUSION Deep cough has a greater detection rate than standard Valsalva maneuver in detecting mild shunt PFO using c TTE.
AIM This study compared the diagnosis values of normal respiration,Valsalva maneuver,and deep cough in right heart contrast transthoracic echocardiography( cTTE) for right to left shunt in patent foramen ovale( PFO). METHODS A total of 396 patients requiring diagnostic exclusion of paradoxical embolism were conducted cTTE. Patients with microbubbles appearing in the left heart were diagnosed as right to left shunt: 1 to 10 microbubbles/frame were classed mild shunt; 11 to 30 microbubbles/frame were classed moderate shunt; > 30 microbubbles/frame were classed severe shunt. The present investigation compared normal respiration,standard Valsalva maneuver,and deep cough in the diagnosis of right to left shunt and explored potential mechanisms. RESULTS 119 cases of PFO with right to left shunt were detected using cTTE,including 28 cases of mild shunt,60 cases of moderate shunt,and 31 cases of severe shunt. There was no difference between standard valsalva maneover and deep cough in detecting moderate and severe shunt. However,there was a significant difference between standard valsalva maneover and deep cough in detecting mild shunt. Deep cough detected more cases than standard valsalva maneover( P < 0. 05). CONCLUSION Deep cough has a greater detection rate than standard Valsalva maneuver in detecting mild shunt PFO using c TTE.
引文
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[7]Mongodi S,Via G,Riccardi M,et al.Patent foramen ovale diagnosis:The importance of provocative maneuvers[J].J Clin Ultrasound,2017,45(1):58-61.
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[9]Lam YY,Yu CM,Zhang Q,et al.Enhanced detection of patent foramen ovale by systematic transthoracic saline contrast echocardiography[J].Int J Cardiol,2011,152(1):24-27.
[2]Yue L,Zhai YN,Wei LQ.Which technique is better for detection of right-to-left shunt in patients with patent foramen ovale:comparing contrast transthoracic echocardiography with contrast transesophageal echocardiography[J].Echocardiography,2014,31(9):1050-1055.
[3]Kim BJ,Kim NY,Kang DW,et al.Provoked right-to-left shunt in patent foramen ovale associates with ischemic stroke in posterior circulation[J].Stroke,2014,45(12):3707-3710.
[4]李越,刘若卓,翟亚楠,等.健康志愿者右心声学造影结果的初步分析[J].中华医学超声杂志(电子版),2014,22(2):135-141.
[5]Zhao E,Wei Y,Zhang Y,et al.A Comparison of Transthroracic Echocardiograpy and Transcranial Doppler With Contrast Agent for Detection of Patent Foramen Ovale With or Without the Valsalva Maneuver[J].Medicine(Baltimore),2015,94(43):e1937.
[6]Sun YP,Homma S.Patent Foramen Ovale and Stroke[J].Circ J,2016,80(8):1665-1673.
[7]Mongodi S,Via G,Riccardi M,et al.Patent foramen ovale diagnosis:The importance of provocative maneuvers[J].J Clin Ultrasound,2017,45(1):58-61.
[8]Boissier F,Razazi K,Thille AW,et al.Echocardiographic detection of transpulmonary bubble transit during acute respiratory distress syndrome[J].Ann Intensive Care,2015,5:5.
[9]Lam YY,Yu CM,Zhang Q,et al.Enhanced detection of patent foramen ovale by systematic transthoracic saline contrast echocardiography[J].Int J Cardiol,2011,152(1):24-27.