Oxygen inhalation can differentiate gaseous from nongaseous microemboli detected by transcranial Doppler ultrasound.
OBJECTIVE
Clinically silent circulating microemboli can be detected by transcranial Doppler sonography. The composition of these emboli in different clinical conditions is unclear.


METHODS
We performed 1-hour transcranial Doppler sonographic recordings from the middle cerebral or posterior cerebral artery in 20 patients with mechanical prosthetic heart valves, in 78 patients with an arterial embolic source, and in 20 control subjects. During 30 minutes of this recording, the patients inspired room air and 6 L of oxygen per minute via a loosely fitting facial mask; during the remaining 30 minutes, they breathed room air only.


RESULTS
There was a significant decline of embolic signals (ES) under oxygen in the patients with mechanical prosthetic cardiac valves (144 ES without oxygen versus 63 ES with oxygen; P = .002) but not in the patients with arterial embolic sources (145 ES without oxygen versus 135 ES with oxygen; P = NS). In the control subjects, no ES were found.


CONCLUSIONS
ES in patients with mechanical prosthetic cardiac valves correspond mainly to gas bubbles. Oxygen inhibits the cavitation process of mechanical prosthetic heart valves or speeds up redissolution of gas bubbles generated by cavitation. In contrast, solid microemboli originating from thrombus or atheroma cannot be suppressed by oxygen inhalation. This simple method of oxygen inhalation should help to clarify the composition of microemboli in various clinical and experimental settings.
Droste
D W
DW
Department of Neurology, University of Münster, Germany.
Hansberg
T
T
Kemény
V
V
Hammel
D
D
Schulte-Altedorneburg
G
G
Nabavi
D G
DG
Kaps
M
M
Scheld
H H
HH
Ringelstein
E B
EB
D000280:Administration, Inhalation; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D004618:Embolism, Air / Q000000981:diagnostic imaging* / Q000209:etiology; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage; D012016:Reference Values; D017585:Ultrasonography, Doppler, Transcranial
D010100:Oxygen