title: Valsalva maneuver procedures in the diagnosis of right-to-left shunt by contrast-enhanced transcranial doppler using agitated saline solution with blood as a contrast agent.
abstract: OBJECTIVE
  To compare two different timings for the performance of the Valsalva maneuver (VM) using an infusion of agitated saline solution with blood as contrast agent (CA) to right-to-left shunt (RLS) screening.
  
  
  METHODS
  42 patients were submitted to a standardized contrast-enhanced transcranial doppler (cTCD) to screen for right-to-left shunt (RLS). cTCD technique was done with two different moments of the VM: [1] the CA injection during the VM (CAduringVM test); [2] the CA injection before the VM (CApreVM test).
  
  
  RESULTS
  Positive MCA tests were observed in 47 (56%) CAduringVM tests and in 50 (59.5%) CApreVM tests, p=0.64. There was an almost perfect agreement for the positive tests between the CAduringVM and CApreVM test, r s=0.829 (95% CI 0.61-1.00, p<0.001).
  
  
  CONCLUSIONS
  The present study demonstrates that there is no significant difference in the results of RLS screening by cTCD when two different moments of VM were done.
authors.affiliation: Neurology Division Cerebrovascular Diseases Unit, Internal Medicine Department, Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR, Brazil. lange@ufpr.br
authors.forename: Marcos Christiano
authors.initials: MC
authors.lastname: Lange
authors.forename: Viviane Flumignan
authors.initials: VF
authors.lastname: Zétola
authors.forename: Elcio Juliato
authors.initials: EJ
authors.lastname: Piovesan
authors.forename: Lineu César
authors.initials: LC
authors.lastname: Werneck
mesh_terms: D000328:Adult; D003287:Contrast Media; D019320:Embolism, Paradoxical / Q000175:diagnosis / Q000000981:diagnostic imaging*; D005260:Female; D006801:Humans; D008297:Male; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012965:Sodium Chloride; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014636:Valsalva Maneuver
chemical_list: D003287:Contrast Media; D012965:Sodium Chloride