Atrial septal defect transcranial doppler ultrasound: Difference between revisions
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/* ACC / AHA Guidelines - Evaluation of the Unoperated Patient (DO NOT EDIT){{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congen... |
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{{Atrial septal defect}} | {{Atrial septal defect}} | ||
{{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] | {{CMG}}; '''Associate Editor(s)-In-Chief:''' [[Priyamvada Singh|Priyamvada Singh, M.B.B.S.]] [mailto:psingh13579@gmail.com]; {{CZ}}; '''Assistant Editor(s)-In-Chief:''' [[Kristin Feeney|Kristin Feeney, B.S.]] [mailto:kfeeney@elon.edu] | ||
==Overview== | ==Overview== | ||
Transcranial doppler ultrasound is a diagnostic tool that involves a simple [[intravenous injection]] of saline under minimal [[sedation]]. It is primarily utilized to further diagnostically evaluate a [[patent foramen ovale]] defect. | |||
==Transcranial Doppler Ultrasound== | ==Transcranial Doppler Ultrasound== | ||
* Transcranial | * Transcranial doppler ultrasound bubble test can be used to determine hemodynamic interaction between [[atria]] of the [[heart]]. | ||
* Non-invasive ultrasound method | * Non-invasive [[ultrasound]] method. | ||
* Operated by a hand-held | * Operated by a hand-held doppler transducer that functions on a pulsating low-frequency. | ||
* Requires no sedation | * Requires no [[sedation]]. | ||
* Involves a simple intravenous injection of saline solution | * Involves a simple [[intravenous injection]] of saline solution. | ||
* Used as a testing standard in clinical trials of patent foramen ovale closure devices and in studies ivestigating the relationship and interconnectivity of patent foramen ovale, stroke and | * Used as a testing standard in clinical trials of [[patent foramen ovale]] closure devices and in studies ivestigating the relationship and interconnectivity of [[patent foramen ovale]], [[stroke]] and [[migraine]]s. | ||
===Indications=== | ===Indications=== | ||
* Effective in detecting narrowing of cerebral arteries | * Effective in detecting narrowing of [[cerebral arteries]]. | ||
* Effective in measuring hemodynamic circulation patterns within occluded diseased cerebral arteries | * Effective in measuring hemodynamic circulation patterns within occluded diseased [[cerebral artery|cerebral arteries]]. | ||
* Effectively measures: | * Effectively measures: | ||
:* Peak systolic velocity | :* Peak [[systolic]] velocity | ||
:* Peak diastolic velocity | :* Peak [[diastolic]] velocity | ||
:* Mean velocity | :* Mean velocity | ||
:* | :* Pulsatility | ||
===Advantages=== | ===Advantages=== | ||
* Usage of | * Usage of [[valsalva maneuver]] during testing can increase the visibility and overall detection of an atrial septal defect | ||
* Less invasive than other methods | * Less invasive than other methods | ||
* Cost effective | * Cost effective | ||
| Line 31: | Line 30: | ||
===Common Findings=== | ===Common Findings=== | ||
* A defect may present in two ways: | * A defect may present in two ways: | ||
:* Small right-to-left shunt at start of systole ( | :* Small right-to-left shunt at start of [[systole]] (biphasic), associated with [[patent foramen ovale]]. | ||
:* Larger left-to-right shunt, associated primarily with atrial septal defect | :* Larger left-to-right shunt, associated primarily with atrial septal defect. | ||
* Visualization of bubbles in the left atrium and left ventricle | * Visualization of bubbles in the [[left atrium]] and [[left ventricle]]. | ||
===Supportive Trial Data=== | |||
=== | * Transcranial Doppler ultrasound Bubble study has minimal or no complications.<ref name="pmid20971751">{{cite journal| author=Tsivgoulis G, Stamboulis E, Sharma VK, Heliopoulos I, Voumvourakis K, Teoh HL et al.| title=Safety of transcranial Doppler 'bubble study' for identification of right to left shunts: an international multicentre study. | journal=J Neurol Neurosurg Psychiatry | year= 2010 | volume= | issue= | pages= | pmid=20971751 | doi=10.1136/jnnp.2010.219733 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20971751 }} </ref> | ||
* One study which detected an incidence of adverse events of 0.3% or greater and found 0 events; indicating a high confidence interval (alpha value was 0.05).<ref name="pmid20971751">{{cite journal| author=Tsivgoulis G, Stamboulis E, Sharma VK, Heliopoulos I, Voumvourakis K, Teoh HL et al.| title=Safety of transcranial Doppler 'bubble study' for identification of right to left shunts: an international multicentre study. | journal=J Neurol Neurosurg Psychiatry | year= 2010 | volume= | issue= | pages= | pmid=20971751 | doi=10.1136/jnnp.2010.219733 | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=20971751 }} </ref> | |||
==2008 ACC / AHA Guidelines - Evaluation of the Unoperated Patient- Atrial Septal Defect (DO NOT EDIT)<ref name="pmid19038677">{{cite journal| author=Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA et al.| title=ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons. | journal=J Am Coll Cardiol| year= 2008 | volume= 52 | issue= 23 | pages= e1-121 | pmid=19038677 | doi=10.1016/j.jacc.2008.10.001 |pmc=|url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19038677 }} </ref>== | |||
{| class="wikitable" | {| class="wikitable" | ||
|- | |- | ||
| colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | | colspan="1" style="text-align:center; background:LightGreen"|[[ACC AHA guidelines classification scheme#Classification of Recommendations|Class I]] | ||
|- | |- | ||
| bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. ([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]]) | | bgcolor="LightGreen"|<nowiki>"</nowiki>'''1.''' ASD should be diagnosed by imaging techniques with demonstration of [[shunting]] across the defect and evidence of RV volume overload and any associated anomalies. ''([[ACC AHA guidelines classification scheme#Level of Evidence|Level of Evidence: C]])'' <nowiki>"</nowiki> | ||
|} | |} | ||
==References== | ==References== | ||
{{ | {{reflist|2}} | ||
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[[Category:Congenital heart disease]] | [[Category:Congenital heart disease]] | ||
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[[Category:Embryology]] | [[Category:Embryology]] | ||
[[Category:Disease]] | [[Category:Disease]] | ||
Latest revision as of 02:29, 15 March 2016
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-In-Chief: Priyamvada Singh, M.B.B.S. [2]; Cafer Zorkun, M.D., Ph.D. [3]; Assistant Editor(s)-In-Chief: Kristin Feeney, B.S. [4]
Overview
Transcranial doppler ultrasound is a diagnostic tool that involves a simple intravenous injection of saline under minimal sedation. It is primarily utilized to further diagnostically evaluate a patent foramen ovale defect.
Transcranial Doppler Ultrasound
- Transcranial doppler ultrasound bubble test can be used to determine hemodynamic interaction between atria of the heart.
- Non-invasive ultrasound method.
- Operated by a hand-held doppler transducer that functions on a pulsating low-frequency.
- Requires no sedation.
- Involves a simple intravenous injection of saline solution.
- Used as a testing standard in clinical trials of patent foramen ovale closure devices and in studies ivestigating the relationship and interconnectivity of patent foramen ovale, stroke and migraines.
Indications
- Effective in detecting narrowing of cerebral arteries.
- Effective in measuring hemodynamic circulation patterns within occluded diseased cerebral arteries.
- Effectively measures:
Advantages
- Usage of valsalva maneuver during testing can increase the visibility and overall detection of an atrial septal defect
- Less invasive than other methods
- Cost effective
- Can be completed in under an hour
Common Findings
- A defect may present in two ways:
- Small right-to-left shunt at start of systole (biphasic), associated with patent foramen ovale.
- Larger left-to-right shunt, associated primarily with atrial septal defect.
- Visualization of bubbles in the left atrium and left ventricle.
Supportive Trial Data
- Transcranial Doppler ultrasound Bubble study has minimal or no complications.[1]
- One study which detected an incidence of adverse events of 0.3% or greater and found 0 events; indicating a high confidence interval (alpha value was 0.05).[1]
2008 ACC / AHA Guidelines - Evaluation of the Unoperated Patient- Atrial Septal Defect (DO NOT EDIT)[2]
| Class I |
| "1. ASD should be diagnosed by imaging techniques with demonstration of shunting across the defect and evidence of RV volume overload and any associated anomalies. (Level of Evidence: C) " |
References
- ↑ 1.0 1.1 Tsivgoulis G, Stamboulis E, Sharma VK, Heliopoulos I, Voumvourakis K, Teoh HL; et al. (2010). "Safety of transcranial Doppler 'bubble study' for identification of right to left shunts: an international multicentre study". J Neurol Neurosurg Psychiatry. doi:10.1136/jnnp.2010.219733. PMID 20971751.
- ↑ Warnes CA, Williams RG, Bashore TM, Child JS, Connolly HM, Dearani JA; et al. (2008). "ACC/AHA 2008 guidelines for the management of adults with congenital heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Develop Guidelines on the Management of Adults With Congenital Heart Disease). Developed in Collaboration With the American Society of Echocardiography, Heart Rhythm Society, International Society for Adult Congenital Heart Disease, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". J Am Coll Cardiol. 52 (23): e1–121. doi:10.1016/j.jacc.2008.10.001. PMID 19038677.