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Updated: Mar 14, 2026
Morphological and Functional Assessment of the Right Ventricle Using 3D Echocardiography
Published on: October 28, 2020
Modified Right Heart Contrast Echocardiography Versus Traditional Method in Diagnosis of Right-to-Left Shunt: A
Yi Wang1, Jie Zeng2, Lixue Yin3
1Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China.
Insights
A modified right heart contrast transthoracic echocardiography (cTTE) method using agitated saline and blood reliably detects cardiovascular right-to-left shunts (RLS). This enhanced technique offers improved diagnostic accuracy over traditional methods.
Area of Science:
- Cardiology
- Medical Imaging
- Diagnostic Techniques
Background:
- Right-to-left shunts (RLS) can be challenging to diagnose accurately.
- Traditional echocardiography methods may have limitations in RLS detection.
Purpose of the Study:
- To evaluate the reliability, effectiveness, and safety of a modified right heart contrast transthoracic echocardiography (cTTE) method.
- To compare the modified cTTE with the traditional method for RLS detection.
Main Methods:
- A modified cTTE technique was developed using saline agitated with a small sample of the patient's blood.
- Microscopic analysis assessed bubble characteristics and red blood cell morphology.
- 40 patients with suspected RLS underwent both modified and traditional cTTE, with comparisons of oxygen saturation, transit time, RLS presence, and biochemical markers.
Main Results:
- The modified method generated significantly more bubbles (P<0.05) but did not alter bubble size significantly (P>0.05).
- RLS was diagnosed in 60% of patients using the modified method versus 40% with the traditional method.
- The modified contrast agent agitated 20 times showed the shortest transit time and highest RLS detection rate.
Conclusions:
- Modified right heart contrast echocardiography is a reliable, effective, and safe method for detecting cardiovascular RLS.
- The enhanced technique improves diagnostic yield for RLS compared to conventional approaches.
Background:
The purpose of this study was to evaluate the reliability, effectiveness, and safety of modified right heart contrast transthoracic echocardiography (cTTE) in comparison with the traditional method.
Material/Methods:
We performed a modified right heart cTTE using saline mixed with a small sample of patient's own blood. Samples were agitated with varying intensity. This study protocol involved microscopic analysis and patient evaluation. 1. Microscopic analysis: After two contrast samples had been agitated 10 or 20 times, they underwent a comparison of bubble size, bubble number, and red blood cell morphology. 2. Patient analysis: 40 patients with suspected RLS (right- to-left shunt) were enrolled. All patients underwent right heart contrast echocardiography. Oxygen saturation, transit time and duration, presence of RLS, change in indirect bilirubin and urobilinogen concentrations were compared afterward.
Results:
Modified method generated more bubbles (P<0.05), but the differences in bubble size were not significant (P>0.05). Twenty-four patients were diagnosed with RLS (60%) using the modified method compared to 16 patients (40%) with the traditional method. The transit time of ASb20 group was the shortest (P<0.05). However, the duration time in this group was much longer (P<0.05). Also, in semi-quantitative analysis mean rank of RLS was higher after injecting the modified contrast agent agitated 20 times (P<0.05).
Conclusions:
Modified right heart contrast echocardiography is a reliable, effective and safe method of detecting cardiovascular RLS.
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