Contrast‐enhanced transcranial Doppler for the detection of right‐to‐left shunt: A new provocation method with a syringe‐modified Valsalva maneuver

Abstract

Abstract Background Contrast‐enhanced transcranial Doppler (cTCD) study has been established as one of the most common investigations for detecting right‐to‐left shunt (RLS). Although the conventional Valsalva maneuver (c‐VM) has been used to increase the sensitivity of cTCD for RLS, efforts are still needed to improve the detection rate further. We proposed a new provocation method with a syringe‐modified Valsalva maneuver (sm‐VM) during cTCD and compared the efficacy of this strategy with cTCD measured at resting and with the provocation of c‐VM. Methods Consecutive patients with suspicion of RLS who underwent cTCD in our institution between September 27, 2021, and April 1, 2022, were included in this study. Examination of cTCD was performed separately at the resting state and provoked with c‐VM and sm‐VM. The overall proportion of patients with RLS and their distribution with different RLS grades were compared. Results A total of 389 patients (mean age: 49.37 years, male: 52.2%) were included in this study. The positive rate for RLS was significantly higher for cTCD detected with sm‐VM than those detected at resting state and with c‐VM (46.8% vs. 21.6% and 34.2%, all p < .05). Besides, cTCD detected with sm‐VM was also associated with a higher proportion of patients with grade III RLS than those detected at resting state and with c‐VM (11.3% vs. 1.8% and 0%, all p < .05). Conclusions Compared to cTCD detected at resting state and with c‐VM, cTCD with sm‐VM could further increase the positive detection rate of RLS.

Keywords

• contrast‐enhanced transcranial doppler
• detection rate
• right‐to‐left shunt
• Valsalva maneuver