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[Diagnosis of interatrial communication with contrast echocardiography]
Insights
Contrast echocardiography effectively detects shunts in atrial septal defects and patent foramen ovale. This imaging technique identifies both right-to-left and left-to-right shunts in patients with these heart conditions.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Context:
- Interatrial communications, including atrial septal defects (ASD) and patent foramen ovale (PFO), are common congenital heart conditions.
- Accurate detection and quantification of shunts are crucial for patient management and prognosis.
- Traditional diagnostic methods may have limitations in fully characterizing shunt dynamics.
Purpose:
- To evaluate the efficacy of M-mode and two-dimensional contrast echocardiography in detecting right-to-left (R-L) and left-to-right (L-R) shunts in patients with interatrial communications.
- To assess the influence of resting conditions and the Valsalva maneuver on shunt detection.
Summary:
- M-mode contrast echocardiography identified R-L shunts in 85% of ASD cases and 37% of PFO cases at rest.
- The Valsalva maneuver increased or provoked R-L shunts in a significant proportion of patients.
- Two-dimensional contrast echocardiography demonstrated L-R shunts in 79% of uncomplicated ASD cases.
- Combined techniques detected either R-L or L-R shunts in all examined patients with ASD.
Impact:
- Contrast echocardiography is a sensitive tool for diagnosing shunts associated with ASD and PFO.
- The Valsalva maneuver enhances the detection of R-L shunts, providing valuable hemodynamic information.
- Comprehensive echocardiographic assessment can demonstrate shunts in all patients with atrial septal defects, aiding clinical decision-making.
Abstract:
M-mode contrast echocardiography with peripheral venous injections was performed in 73 patients with interatrial communications: 48 with atrial septal defect, 19 with a patent foramen ovale, and six with complex congenital heart disease in addition to their atrial septal defect. During resting conditions a cross-over of echo-contrast from the right to the left atrium indicating a right to left shunt was observed in 41/48 (= 85%) of the atrial septal defect cases, including all with and 82% of those without Eisenmenger's reaction, in 7/19 (= 37%) with patent foramen ovale and in 83% of all examined patients. The echocardiographically detectable right to left shunt could often be increased or provoked by repeating injections during the Valsalva maneuver. Positive contrast studies either at rest or with Valsalva provocation were observed in 94% of the atrial septal defect group and 63% of the patients with patent foramen ovale. Two-dimensional contrast echocardiography was somewhat less sensitive in detecting right to left shunts, but allowed the demonstration of the left to right shunt in 79% of the patients with uncomplicated atrial septal defect. The left to right shunt was seen as a stream of contrast free left atrial blood entering the contrast filled right heart through the defect and causing a "wash out" phenomenon. When all available techniques were applied, either a right to left shunt (rest and/or Valsalva maneuver) or a left to right shunt was demonstrable in all cases of atrial septal defects.(ABSTRACT TRUNCATED AT 250 WORDS)