Elsevier

American Heart Journal

Volume 125, Issue 4, April 1993, Pages 1136-1141
American Heart Journal

The diagnostic utility of contrast echocardiography in patients with refractory hypoxemia

https://doi.org/10.1016/0002-8703(93)90126-TGet rights and content

Abstract

Three illustrative cases of refractory hypoxemia in adults are presented. In two cases contrast echocardiography was invaluable in establishing the diagnosis of a true anatomic right to left shunt, as well as in localizing the shunt to an intracardiac or extracardiac site. In the third case true anatomic right to left shunt was excluded by means of contrast echocardiography. The pathophysiology of hypoxemia is discussed with emphasis on the potential diagnostic utility of contrast echocardiology in patients with refractory hypoxemia. A diagnostic flow chart is proposed (Fig. 1).

References (39)

  • JB Seward et al.

    Peripheral venous contrast echocardiography

    Am J Cardiol

    (1977)
  • O Dubourg et al.

    Contrast echocardiographic visualization of cough induced right to left shunt through a patent foramen ovale

    J Am Coll Cardiol

    (1984)
  • JJ Lynch et al.

    Prevalence of right to left atrial shunting in a healthy population: detection by Valsalva maneuver contrast echocardiography

    Am J Cardiol

    (1984)
  • G Kronik et al.

    Positive contrast echocardiography in patients with patent foramen ovale and normal right heart dynamics

    Am J Cardiol

    (1982)
  • JJ Nemec et al.

    Detection and evaluation of intrapulmonary vascular shunt with “contrast Doppler” transesophageal echocardiography

    J Am Soc Echocardiogr

    (1991)
  • WJ Bommer et al.

    The safety of contrast echocardiography: report of the committee on contrast echocardiography for the American Society of Echocardiography

    J Am Coll Cardiol

    (1984)
  • GF Fraser et al.

    Diagnosis of diseases of the chest

    (1988)
  • PH Lechat et al.

    Prevalence of patent foramen ovale in patients with stroke

    N Engl J Med

    (1988)
  • S Black et al.

    Preoperative and intraoperative echocardiography to detect right to left shunting in patients undergoing neurosurgical procedures in the sitting position

    Anesthesiology

    (1990)
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