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Detektion kardialer und extrakardialer Rechts-links-Shunts bei jüngeren Schlaganfallpatienten

Detection of cardial and extracardial right-to-left shunts in young stroke patients

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Zusammenfassung

Hintergrund

Ziel dieser Studie war es, Hinweise auf die Häufigkeit extrakardialer, v. a. pulmonaler Rechts-links-Shunts (RLS) bei Patienten mit akuter zerebraler Ischämie unklarer Ursache zu erlangen.

Patienten und Methoden

Bei 52 Patienten unter 60 Jahren mit einer zerebralen Ischämie unklarer Ursache wurden eine transösophageale Echokardiographie (TEE) mit besonderer Beachtung einer späten Anflutung von Kontrastmittel (KM) im linken Vorhof und eine transkranielle Dopplersonographie (TCD) mit KM durchgeführt.

Ergebnisse

Im TEE wiesen 25 Patienten (48%) einen kardialen RLS auf. Bei 7 Patienten mit unauffälligem TEE (13,5%) fand sich mittels TCD mit KM ein Hinweis auf einen RLS (spontaner RLS n=4, nach Valsalva-Manöver n=3). Bei keinem dieser 7 Patienten fand sich jedoch im TEE eine verzögerte Anflutung von KM im linken Vorhof.

Schlussfolgerung

Die Konstellation eines RLS-Nachweises lediglich im TCD mit KM aber nicht im TEE ist häufig und lässt insbesondere bei den spontanen RLS den Verdacht auf einen pulmonalen Shunt hegen. Unser erweitertes TEE-Protokoll ergab jedoch keinen zusätzlichen Beleg für eine pulmonale Shuntgenese.

Summary

Background

The aim of this study was to determine the frequency of extracardial and particularly pulmonal right-to-left-shunts (RLS) in patients with acute cerebral ischemia of unknown origin.

Patients and Methods

We investigated 52 patients under 60 years of age with cerebral ischemic stroke of unknown origin using transesophageal echocardiography (TEE) with special attention to the late phase of ultrasound contrast medium in the left atrium. Additionally we performed contrast transcranial doppler sonography (TCD).

Results

In the TEE, 25 patients (48%) showed cardial RLS. In seven patients with normal TEE (13.5%) we found evidence of RLS with contrast TCD (spontaneous RLS n=4, RLS after valsalva n=3). In none of these seven patients did we find late-phase contrast in the left atrium.

Conclusion

The constellation of RLS detection in contrast TCD but not in TEE was frequently found. Particularly in spontaneous RLS, this constellation raises the suspicion of a pulmonary shunt. However our extended TEE protocol did not give additional evidence for a pulmonary location of the shunt.

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Authors and Affiliations

  1. Zentrum der Psychiatrie, Klinikum der Johann-Wolfgang-Goethe-Universität, Heinrich-Hoffmann-Straße 10, 60528, Frankfurt am Main, Deutschland

    V. Sirkis

  2. Neurologische Klinik, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland

    V. Sirkis, S. Gass & A. Grau

  3. Medizinische Klinik 8, Kardiologie, Klinikum Nürnberg Süd, Nürnberg, Deutschland

    B. Fraiture & R. Zahn

  4. Zentralinstitut für Röntgendiagnostik, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland

    G. Layer

  5. Herzzentrum, Kardiologie, Klinikum der Stadt Ludwigshafen, Ludwigshafen, Deutschland

    J. Senges

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  1. V. Sirkis
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  2. B. Fraiture
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  3. S. Gass
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  4. G. Layer
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  5. R. Zahn
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  6. J. Senges
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  7. A. Grau
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Correspondence to V. Sirkis.

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Sirkis, V., Fraiture, B., Gass, S. et al. Detektion kardialer und extrakardialer Rechts-links-Shunts bei jüngeren Schlaganfallpatienten. Nervenarzt 79, 195–201 (2008). https://doi.org/10.1007/s00115-007-2346-5

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  • DOI: https://doi.org/10.1007/s00115-007-2346-5

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