Atrial septal defect transcranial doppler ultrasound

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:

Peak systolic velocity
Peak diastolic velocity
Mean velocity
Pulsatility

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]

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.

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[pmid20971751-1] 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.

[pmid19038677-2] 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.

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