Modified Right Heart Contrast Echocardiography Versus Traditional Method in Diagnosis of Right-to-Left Shunt: A Comparative Study.
BACKGROUND
The purpose of this study was to evaluate the reliability, effectiveness, and safety of modified right heart contrast transthoracic echocardiography (cTTE) in comparison with the traditional method.


METHODS
We performed a modified right heart cTTE using saline mixed with a small sample of patient's own blood. Samples were agitated with varying intensity. This study protocol involved microscopic analysis and patient evaluation. 1. Microscopic analysis: After two contrast samples had been agitated 10 or 20 times, they underwent a comparison of bubble size, bubble number, and red blood cell morphology. 2. Patient analysis: 40 patients with suspected RLS (right- to-left shunt) were enrolled. All patients underwent right heart contrast echocardiography. Oxygen saturation, transit time and duration, presence of RLS, change in indirect bilirubin and urobilinogen concentrations were compared afterward.


RESULTS
Modified method generated more bubbles (P<0.05), but the differences in bubble size were not significant (P>0.05). Twenty-four patients were diagnosed with RLS (60%) using the modified method compared to 16 patients (40%) with the traditional method. The transit time of ASb20 group was the shortest (P<0.05). However, the duration time in this group was much longer (P<0.05). Also, in semi-quantitative analysis mean rank of RLS was higher after injecting the modified contrast agent agitated 20 times (P<0.05).


CONCLUSIONS
Modified right heart contrast echocardiography is a reliable, effective and safe method of detecting cardiovascular RLS.
Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China; Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China.
Yi
Y
Wang
Department of Cardiology, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China.
Jie
J
Zeng
Institute of Ultrasound Medicine, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Chengdu, Sichuan, P.R. China.
Lixue
L
Yin
Department of Cardiology, Qilu Hospital of Shandong University, Jinan, Shandong, P.R. China.
Mei
M
Zhang
Department of Medical Image, Shandong Chest Hospital, Jinan, Shandong, P.R. China.
Dailun
D
Hou
Contrast Media; Echocardiography; Microbubbles
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