Right-to-left shunt detection using contrast-enhanced transcranial Doppler: A comparison of provocation maneuvers between coughing and a modified Valsalva maneuverReportar como inadecuado




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Contrast-enhanced transcranial Doppler c-TCD has been used to detect right-to-left shunts RLS because it is highly sensitive and cost-effective. The use of provocation maneuvers, such as physiologic maneuvers e.g., coughing and the Valsalva maneuver VM to transiently increase right atrial pressure and induce RLS increases the sensitivity of RLS detection. In this study, we sought to determine whether coughing is as effective as the VM in aiding the detection of RLS. We evaluated 162 subjects for RLS, using c-TCD under three different conditions: i resting state, ii coughing, and iii modified VM m-VM, which involved blowing into a tube connected to a sphygmomanometer at 40 mmHg for 10 s. The positive rate of RLS detection with the m-VM was significantly higher than that with coughing. In addition, a difference between the two maneuvers was observed in terms of the degree of RLS seen. The m-VM should be widely used to detect RLS, because it is reliable, standardized, and cost-effective.



Autor: Si-Bo Wang, Xiao-Cong Wang, Yan Ma, Kang-Ding Liu , Ying-Qi Xing

Fuente: http://plos.srce.hr/



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