The Comparison Of Diagnosis Of Right-to-Left Shunt In Patients With Patent Foramen Ovale Using Transthoracic Echocardiography And Transcranial Doppler

Background and purpose:PFO-RLS accounts for 95% of all RLS diseases.A large number of studies have shown that PFO is associated with a series of cerebrovascular events.The mechanism is that the left and right atriums had an openning,providing a communication for paradoxical embolism,and the paradoxical embolization enters the arterial circulation with right to left paradoxical blood flow,resulting in cryptogenic stroke,recurrent stroke,transient ischemic attack,migraine and other diseases.Therefore,the clinical diagnosis of PFO-RLS and the evaluation of the flow classification have become the focus of research.The transesophageal echocardiography caused the patient discomfort,TEE can not be used widely when detecting PFO clinically,At present,c-TTE、c-TCD two methods of examination are widely used,but for what kind of methods for PFO detection and classification is more effective,different studies hold different views.Therefore,this study recruited the patients who had headache in the Department of Neurology,First Hospital of Jilin University and simultaneously performed c-TTE and c-TCD to identify the value of the two methods in the diagnosis of PFO-RLS and assessment of RLS classification.Objects and methods:In this study,231 patients were admitted to the Department of Neurology,First Hospital of Jilin University due to headaches.Both c-TTE and c-TCD were performed simultaneously at rest,after performing traditional Valsalva Manoeuvre and performing standardized Valsalva Manoeuvre.c-TTE and c-TCD were divided into 4 grades based on the number of microbubbles.The RLS is classified according to the c-TCD examination.The positive rate and semi-quantitative classification of RLS were compared.The classification of different types of RLS was compared.Results:In this study,231 patients were recruited,including 158 women,accounting for 68.4%,and 73 males,accounting for 31.6%,with an average age of 36.9±11.6 years.Compared with the two methods,the positive rate of RLS detected by c-TTE was higher than that of c-TCD at RS,after traditional Valsalva Manoeuvre and standardized Valsalva Manoeuvre,and the differences were statistically significant(P <0.001).Evaluation of PFO-RLS grade c-TTE examination was superior to c-TCD examination and the difference was statistically significant(H=6.533 P < 0.001).Constant RLS grade is higher than the stimulated provoked RLS grade by c-TCD and the difference was statistically significant(Z=-3.832 p<0.001);Whereas the RLS grade of constant RLS and provoked RLS by c-TTE difference was not statistically significant(Z=-1.234 p=0.217).The c-TCD examination divided the patients into RLS positive group and RLS negative group,and evaluated the two groups of RLS by c-TTE,which positive group was higher than the negative group,and the difference was statistically significant(Z=-5.150 p<0.001).A total of 5 patients were detected with atrial septal aneurysm(ASA),After the Valsalva Manoeuvre,the shunt volume increased.Conclusion:1:c-TTE was superior to c-TCD in the diagnosis of PFO-RLS positive rate and evaluation of RLS grading.2:c-TCD evaluated that the constant RLS shunt was greater than that of the provoked RLS,and that c-TCD was superior to c-TTE for the comparison of different types of RLS grading.3:Patients who need to detect RLS suggest that c-TTE and c-TCD can be used in combination to improve the positive rate of PFO-RLS and to evaluate different types of RLS grade.4:In this study,the PFO-RLS shunt of ASA was larger,and the RLS shunt was higher than that after Valsalva.