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Vol. 17, No. 2-3, 2004
Issue release date: March 2004
Section title: Original Paper
Cerebrovasc Dis 2004;17:191–196
(DOI:10.1159/000075790)

Right-to-Left-Shunts Detected by Transesophageal Echocardiography and Transcranial Doppler Sonography

Droste D.W. · Schmidt-Rimpler C. · Wichter T. · Dittrich R. · Ritter M. · Stypmann J. · Ringelstein E.B.
Departments of aNeurology and bCardiology and Angiology, University of Münster, Münster, Germany

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Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/21/2003
Accepted: 7/30/2003
Published online: 12/23/2003

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED

Abstract

Background: Transesophageal echocardiography (TEE) and transcranial Doppler sonography (TCD) can identify right-to-left-shunts that predispose to paradoxical embolism. In a large cohort we compared the results of both techniques. Methods: 222 patients were investigated by both techniques using the contrast agent Echovist®-300 and performing each test once without and once with the Valsalva maneuver (VM). Results: TEE-proven right-to-left-shunts were detected by TCD with a high sensitivity of 94%. In addition, TCD revealed shunts not noted during TEE in about 20% of all patients studied. These shunts are in general smaller than those concordantly identified; however, 9% of the patients without a TEE-proven shunt presented with a shunt that allows a considerable amount of contrast medium to pass. There were 12% more microbubbles detected in the right middle cerebral artery than in the left middle cerebral artery during the TCD test performed with VM, but not during the TCD test performed without VM. Conclusions: Contrast-enhanced TEE and TCD are complementary methods in the assessment of stroke and stroke-prone patients. The side difference of microbubbles may indicate a selective streaming of cardiac emboli during VM.


Article / Publication Details

First-Page Preview
Abstract of Original Paper

Received: 3/21/2003
Accepted: 7/30/2003
Published online: 12/23/2003

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 4

ISSN: 1015-9770 (Print)
eISSN: 1421-9786 (Online)

For additional information: http://www.karger.com/CED


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Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
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