[Detection of cardial and extracardial right-to-left shunts in young stroke patients].
BACKGROUND
The aim of this study was to determine the frequency of extracardial and particularly pulmonal right-to-left-shunts (RLS) in patients with acute cerebral ischemia of unknown origin.


METHODS
We investigated 52 patients under 60 years of age with cerebral ischemic stroke of unknown origin using transesophageal echocardiography (TEE) with special attention to the late phase of ultrasound contrast medium in the left atrium. Additionally we performed contrast transcranial doppler sonography (TCD).


RESULTS
In the TEE, 25 patients (48%) showed cardial RLS. In seven patients with normal TEE (13.5%) we found evidence of RLS with contrast TCD (spontaneous RLS n=4, RLS after valsalva n=3). In none of these seven patients did we find late-phase contrast in the left atrium.


CONCLUSIONS
The constellation of RLS detection in contrast TCD but not in TEE was frequently found. Particularly in spontaneous RLS, this constellation raises the suspicion of a pulmonary shunt. However our extended TEE protocol did not give additional evidence for a pulmonary location of the shunt.
Sirkis
V
V
Zentrum der Psychiatrie, Klinikum der Johann-Wolfgang-Goethe-Universität, Heinrich-Hoffmann-Strasse 10, Frankfurt am Main, Germany. Vladimir.Sirkis@kgu.de
Fraiture
B
B
Gass
S
S
Layer
G
G
Zahn
R
R
Senges
J
J
Grau
A
A
D000328:Adult; D001165:Arteriovenous Malformations / Q000000981:diagnostic imaging*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D002544:Cerebral Infarction / Q000000981:diagnostic imaging*; D003287:Contrast Media / Q000008:administration & dosage; D003937:Diagnosis, Differential; D017548:Echocardiography, Transesophageal; D019320:Embolism, Paradoxical / Q000000981:diagnostic imaging*; D005119:Extravasation of Diagnostic and Therapeutic Materials / Q000000981:diagnostic imaging; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging*; D006325:Heart Atria / Q000000981:diagnostic imaging; D006801:Humans; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging; D008168:Lung / Q000098:blood supply*; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D011134:Polysaccharides; D011667:Pulmonary Veins / Q000000981:diagnostic imaging; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial; D014636:Valsalva Maneuver / Q000502:physiology
D003287:Contrast Media; D011134:Polysaccharides; C040642:SHU 454