Detection of Intracardiac and Intrapulmonary Shunts at Rest and During Exercise Using Saline Contrast Echocardiography

Lovering, Andrew T.; Goodman, Randall D.

doi:10.5772/34892

Cited by 3 publications

(1 citation statement)

References 59 publications

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“…Ultrasound screening. Ultrasound screening has been previously described in detail (26). Initial agitated saline contrast studies were performed with subjects breathing room air and reclined at 45°in the left lateral decubitus position where a clear apical, four-chamber view was obtained.…”

Section: Methodsmentioning

confidence: 99%

Ventilatory responses to acute hypoxia and hypercapnia in humans with a patent foramen ovale

Davis

Boulet

Hardin

et al. 2019

Journal of Applied Physiology

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Subjects with a patent foramen ovale (PFO) have blunted ventilatory acclimatization to high altitude compared with subjects without PFO. The blunted response observed could be because of differences in central and/or peripheral respiratory chemoreflexes. We hypothesized that compared with subjects without a PFO (PFO−), subjects with a PFO (PFO+) would have blunted ventilatory responses to acute hypoxia and hypercapnia. Sixteen PFO+ subjects (9 female) and 15 PFO− subjects (8 female) completed four 20-min trials on the same day: 1) normoxic hypercapnia (NH), 2) hyperoxic hypercapnia (HH), 3) isocapnic hypoxia (IH), and 4) poikilocapnic hypoxia (PH). Hypercapnic trials were completed before the hypoxic trials, the order of the hypercapnic (NH & HH) and hypoxic (IH & PH) trials were randomized, and trials were separated by ≥40 min. During the NH trials but not the HH trials subjects who were PFO+ had a blunted hypercapnic ventilatory response compared with subjects who were PFO− (1.41 ± 0.46 l·min−1·mmHg−1 vs. 1.98 ± 0.71 l·min−1·mmHg−1, P = 0.02). There were no differences between the PFO+ and PFO− subjects with respect to the acute hypoxic ventilatory response during IH and PH trials. Hypoxic ventilatory depression was similar between subjects who were PFO+ and PFO− during IH. These data suggest that compared with subjects who were PFO−, subjects who were PFO+ have normal ventilatory chemosensitivity to acute hypoxia but blunted ventilatory chemosensitivity to carbon dioxide, possibly because of reduced carbon dioxide sensitivity of either the central and/or the peripheral chemoreceptors. NEW & NOTEWORTHY Patent foramen ovale (PFO) is found in ~25%–40% of the population. The presence of a PFO appears to be associated with blunted ventilatory responses during acute exposure to normoxic hypercapnia. The reason for this blunted ventilatory response during acute exposure to normoxic hypercapnia is unknown but may suggest differences in either central and/or peripheral chemoreflex contribution to hypercapnia.

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Section: Methodsmentioning

confidence: 99%

Ventilatory responses to acute hypoxia and hypercapnia in humans with a patent foramen ovale

Davis

Boulet

Hardin

et al. 2019

Journal of Applied Physiology

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Platypnea-Orthodeoxia Syndrome Masked by Delirium in an 85-Year-Old Woman

Brito

Fukushima

Bazan

et al. 2018

Journal of the American Medical Directors Association

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Transthoracic contrast echocardiography for detection of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: How can the process be improved for patient safety?

Fan¹,

Choy²,

Shanks³

et al. 2014

IJDI

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Introduction: Patients with hereditary hemorrhagic telangiectasia (HHT) are at risk for pulmonary arteriovenous malformations (PAVMs). Extracardiac right-to-left shunts due to PAVMs can lead to systemic emboli; clinical sequelae including strokes and brain abscesses. Regular screening is required, with appropriate medical/interventional management to alleviate morbidity and mortality from PAVMs. International HHT guidelines recommend standardized transthoracic contrast echocardiogram (TTCE) with agitated saline (in an HHT Foundation-accredited laboratory) as the initial screening test, and, when needed, non-contrast computerized tomography of the chest (CT Chest) to follow up on a positive TTCE.Case presentation: A 40-year-old woman was seen for evaluation of HHT and referred for TTCE as part of her PAVM screen. Following administration of agitated saline, she developed a headache, visual changes in her right eye, and right arm weakness, followed by posturing and stiffness in her right arm. Her symptoms resolved after five minutes, consistent with a transient ischemic attack (TIA).Clinical impact: Protocols at our institution were amended following this index case and echocardiography laboratory protocols were adjusted to use a maximum of 0.1 cc air to 9.9 cc saline for TTCE studies in the HHT population. Only the attending echocardiologist who is familiar with possible systemic air embolism during bubble contrast echocardiography in patients with HHT should perform agitation and infusion of contrast and should directly review the images for appropriate visualization during the exam for this test to be appropriately interpreted. Paradoxical emboli due to right-to-left shunt are important to recognize. Best practice for PAVM screening in HHT patients includes use of standardized protocols for the performance and reporting of TTCE in the evaluation of pulmonary shunts.

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Detection of Intracardiac and Intrapulmonary Shunts at Rest and During Exercise Using Saline Contrast Echocardiography

Cited by 3 publications

References 59 publications

Ventilatory responses to acute hypoxia and hypercapnia in humans with a patent foramen ovale

Ventilatory responses to acute hypoxia and hypercapnia in humans with a patent foramen ovale

Platypnea-Orthodeoxia Syndrome Masked by Delirium in an 85-Year-Old Woman

Transthoracic contrast echocardiography for detection of pulmonary arteriovenous malformations in hereditary hemorrhagic telangiectasia: How can the process be improved for patient safety?

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