title: Usefulness of contrast echocardiography for detecting right-to-left cardiac shunts during the diagnosis of hypoxemia: 2 case reports.
abstract: We report two cases in which contrast echocardiography was useful for detecting right-to-left shunt. In case 1, a 53-year-old man was admitted to our hospital after being diagnosed with acute heart failure. Even after improvement of the heart failure, hypoxemia remained. Contrast echocardiography was performed. When contrast medium was injected into the left antecubital vein, it directly drained into the left atrium. When contrast medium was injected into the right antecubital vein, it drained into the right atrium not the left atrium. These findings proved the existence of a right-to-left shunt. In case 2, a 68-year-old man felt dyspnea on mild effort, especially when sitting in an anteflexing posture. In room air, his SpO2 was 95% when sitting in a resting posture and 79% when in an anteflexing sitting posture. Contrast echocardiography was performed. A patent foramen ovale (PFO) was proved using the Valsalva maneuver, and the contrast medium drained from right atrium into the left atrium via the PFO. He underwent patch closure of the PFO, and his symptoms disappeared. Contrast echocardiography should be performed for the diagnosis of chronic hypoxemia for which causes are not detected with routine clinical examinations, in order to confirm right-to-left shunt.
authors: Department of Cardiology, Tenri Hospital, 200 Mishimacho, Tenri, Nara 632-8552, Japan.
authors: Jiro
authors: J
authors: Sakamoto
authors: Chisato
authors: C
authors: Izumi
authors: Shuichi
authors: S
authors: Takahashi
authors: Sumiyo
authors: S
authors: Hashiwada
authors: Kazuya
authors: K
authors: Yamao
authors: Kouji
authors: K
authors: Hanazawa
authors: Kazuyasu
authors: K
authors: Yoshitani
authors: Makoto
authors: M
authors: Miyake
authors: Makoto
authors: M
authors: Motooka
authors: Kazuaki
authors: K
authors: Kaitani
authors: Toshiaki
authors: T
authors: Izumi
authors: Hiromitsu
authors: H
authors: Gen
authors: Yoshihisa
authors: Y
authors: Nakagawa
mesh_terms: D000368:Aged; D003287:Contrast Media; D017548:Echocardiography, Transesophageal; D054092:Foramen Ovale, Patent / Q000150:complications / Q000175:diagnosis / Q000000981:diagnostic imaging; D006344:Heart Septal Defects, Atrial / Q000150:complications / Q000000981:diagnostic imaging*; D006801:Humans; D000860:Hypoxia / Q000175:diagnosis* / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011187:Posture / Q000502:physiology; D014636:Valsalva Maneuver
chemical_list: D003287:Contrast Media