Letters to the Editor| Volume 279, ISSUE 1-2, P124-125, April 15, 2009

Download started.


Alternatives to transtemporal approach of transcranial Doppler for the detection of right-to-left cardiac shunt

Published:January 27, 2009DOI:



      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.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Journal of the Neurological Sciences
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Perren F.
        • Savva E.
        • Landis T.
        Transforaminal Doppler: an alternative to transtemporal approach for right-to-left cardiac shunt assessment.
        J Neurol Sci. 2008; 273: 49-50
        • Belvis R.
        • Leta R.G.
        • Marti-Fabregas J.
        • Cocho D.
        • Carreras F.
        • Pons-Llado G.
        • et al.
        Almost perfect concordance between simultaneous transcranial Doppler and transesophageal echocardiography in the quantification of right-to-left shunts.
        J Neuroimaging. 2006; 16: 133-138
        • Jauss M.
        • Kaps M.
        • Keberle M.
        • Haberbosch W.
        • Dorndorf W.
        A comparison of transesophageal echocardiography and transcranial Doppler sonography with contrast medium in the detection of patent foramen ovale.
        Stroke. 1994; 25: 1265-1267
        • Job F.P.
        • Ringelstein E.B.
        • Grafen Y.
        • Flachskampf F.A.
        • Doherty C.
        • Stockmanns A.
        • et al.
        Comparison of transcranial contrast Doppler sonography and transesophageal contrast echocardiography for the detection of patent foramen ovale in young stroke patients.
        Am J Cardiol. 1994; 74: 381-384
        • Del Sette M.
        • Dinia L.
        • Rizzi D.
        • Sugo A.
        • Albano B.
        • Gandolfo C.
        Diagnosis of right-to-left shunt with transcranial Doppler and vertebrobasilar recording.
        Stroke. 2007; 38: 2254-2256
        • Daly K.J.
        Hutchinson S, McCollum CN. Can a peripheral artery be used to detect venous to arterial circulation shunts?.
        Cerebrovasc Dis. 2007; 25: 111-114
        • Spencer M.P.
        • Moehring M.A.
        • Jesurum J.
        • Gray W.A.
        • Olsen J.V.
        • Reisman M.
        Power M-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure.
        J Neuroimaging. 2004; 14: 342-349
        • Schwarze J.J.
        • Sander D.
        • Kukla C.
        • Wittich I.
        • Babikian V.L.
        • Klingelhofer J.
        Methodological parameters influence the detection of right to left shunts by contrast transcranial Doppler ultrasonography.
        Stroke. 1999; 30: 1234-1239
        • Telman G.
        • Kouperberg E.
        • Sprecher E.
        • Yarnitsky D.
        The position of the patients in the diagnosis of patent foramen ovale by transcranial Doppler.
        J Neuroimaging. 2003; 13: 356-358
        • Lao A.Y.
        • Sharma V.K.
        • Tsivgoulis G.
        • Malkoff M.D.
        • Alexandrov A.V.
        • Frey J.L.
        Effect of body positioning during transcranial Doppler detection of right-to-left shunts.
        Eur J Neurol. 2007; 14: 1035-1039