© 2004 by European Society of Cardiology
Copyright © 2003, The European Society of Cardiology
Transthoracic echocardiography using second harmonic imaging with Valsalva manoeuvre for the detection of right to left shunts
Department of Cardiology, John Radcliffe Hospital, Headington, Oxford OX3 9DU, UK
Received 17 February 2003; received in revised form 10 July 2003; accepted after revision 17 July 2003.
* Corresponding author. Tel.: +44-1865-221734; fax: +44-1865-220585. jon.timperley{at}orh.nhs.uk
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Abstract |
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Aims: To assess transthoracic echocardiography (TTE) using second harmonic imaging with Valsalva manoeuvre compared to transesophageal echocardiography (TEE) for the diagnosis of right to left cardiac and pulmonary shunts.
Methods and results: One hundred and ten patients referred for TEE underwent TTE with bubble contrast. Bubbles in the left atrium within three cardiac cycles were considered diagnostic for a patent foramen ovale (PFO) and later as a pulmonary shunt. Greater than 20 bubbles in the left atrium was considered a large shunt and less than 20 a small shunt. TEE was performed immediately afterwards and read blinded to the TTE results. Pick-up rates were similar with 19 TEE positive (13 PFO) and 18 TTE positive (14 PFO) patients. There were five TEE positive/TTE negative cases who had significantly poorer TTE image quality score (2.7±0.8 vs 1.9±0.6, p<0.05). There were six TEE negative/TTE positive cases, two cases requiring Valsalva manoeuvre to become positive. The Valsalva manoeuvre significantly increased the number of bubbles shunting (10±11 vs 20±19, p<0.005).
Conclusion: TTE with Valsalva manoeuvre is as good as TEE in diagnosing shunts. Valsalva manoeuvre increases the size of shunt. Both techniques produce false negative results.
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