title: Comparison of Different Methods of Valsalva Maneuver for Right-to-left Shunt Detection by Contrast-Enhanced Transcranial Doppler.
abstract: We evaluated 298 patients for right-to-left shunt (RLS) detection by contrast-enhanced transcranial Doppler at rest state (RS), during the conventional Valsalva maneuver (CM), and during the modified Valsalva maneuver (BM: blowing into the connecting tube of a sphygmomanometer at 40 mm Hg for 10 s) in random order, and the degree of RLS along the time of the first microbubble occurrence was recorded. The positive rates were 21.8%, 36.9% and 47.3% for RS, CM and BM, respectively (p < 0.001). BM resulted in a significantly higher positive rate (p = 0.010), and there was a significant difference between the two different methods of VM in terms of the degree of RLS detection (p < 0.001). Further, the first microbubble occurred later during BM than CM (10.22 ± 3.77 s vs. 9.44 ± 4.36 s, p < 0.05). This modified maneuver is an alternative to the conventional one, especially for those who cannot perform the conventional maneuver adequately, but are highly suspected of having RLS.
authors.affiliation: Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
authors.forename: Yu-Zhu
authors.initials: YZ
authors.lastname: Guo
authors.affiliation: Department of Cardiac Surgery, First Hospital of Jilin University, Changchun, China.
authors.forename: Yong-Sheng
authors.initials: YS
authors.lastname: Gao
authors.affiliation: Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
authors.forename: Zhen-Ni
authors.initials: ZN
authors.lastname: Guo
authors.affiliation: Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
authors.forename: Peng-Peng
authors.initials: PP
authors.lastname: Niu
authors.affiliation: Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China. Electronic address: doctoryangyi@163.com.
authors.forename: Yi
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Neuroscience Center, Department of Neurology, First Hospital of Jilin University, Changchun, China.
authors.forename: Ying-Qi
authors.initials: YQ
authors.lastname: Xing
mesh_terms: D000328:Adult; D000465:Algorithms; D005260:Female; D054092:Foramen Ovale, Patent / Q000000981:diagnostic imaging*; D006801:Humans; D007089:Image Enhancement / Q000379:methods; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D008297:Male; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014636:Valsalva Maneuver
keywords: Contrast-enhanced transcranial Doppler; Right-to-left shunt; Valsalva maneuver