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A Positive Microbubble Study in Ventricular Septal Defect Patient Without Pulmonary Hypertension
Suqin Jin1, Siyu Zhao1, Xiaoyu Wan2
1Department of Neurology, The Second Hospital of Shandong University, Jinan, China.
JACC. Case Reports
|April 20, 2023
Summary
A stroke patient
Area of Science:
- Cardiology
- Neurology
- Medical Imaging
Background:
- Stroke is a leading cause of disability.
- Paradoxical embolism is a potential cause of ischemic stroke.
- Ventricular septal defects (VSDs) and patent foramen ovale (PFO) can facilitate paradoxical embolism.
Purpose of the Study:
- To investigate the etiology of embolic events in a stroke patient with a supracristal VSD and suspected PFO.
- To identify the mechanism of potential right-to-left shunting.
Main Methods:
- Transthoracic echocardiography (TTE) and transesophageal echocardiography (TEE) were performed.
- An agitated saline microbubble study was utilized.
- Valsalva maneuver was employed to provoke shunting.
Main Results:
- A positive trans-ventricular microbubble jet was detected after Valsalva maneuver.
- This indicated an instantaneous transient paradoxical right-to-left shunt.
- The shunt occurred during late diastole.
Conclusions:
- Transient paradoxical right-to-left shunting through a supracristal VSD may be the cause of embolic events in this stroke patient.
- Echocardiography with microbubble study and Valsalva maneuver is effective in detecting such shunts.
- This finding has implications for stroke prevention strategies.
