Transcranial Doppler (TCD) is reliable and reproducible for the diagnosis of right-to-left cardiac shunts (RLS).
Various factors limiting the performance and diagnostic methods of RLS by TCD are discussed.
In patients with insufficient temporal acoustic windows, TCD may still be reliably used to monitor the microembolic signals at various alternative sites. Diagnostic yield of TCD may be further improved and better quantitative assessment of the ‘functional potential’ of the RLS by optimizing the preparation of the ‘air–saline–blood’ contrast-mixture, injecting the mixture in controlled body positions and using power M-mode TCD.
TCD may be used reliably for the detection as well as the quantification of RLS even in patients with insufficient temporal acoustic windows.
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Published online: January 27, 2009
Accepted: January 6, 2009
Received in revised form: September 4, 2008
Received: August 30, 2008
© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.