We thank Sharma et al. for their comments on our paper which shows that measuring
microembolic signals with transcranial Doppler at the level of the basilar artery
across the foramen magnum (transforaminal approach) is an alternative for the detection
of right-to-left cardiac shunt (RLS) in the absence of temporal bone windows [
[1]
]. We entirely agree with their comments that other extratemporal approaches such as
using the vertebral arteries [
[2]
], the common carotid arteries or even more peripheral arteries such as the contralateral
brachial or femoral arteries [
[3]
] are alternatives for the detection of RLS. Moreover, it appears that a number of
methodological factors, such as the use of power M-mode transcranial Doppler with
its multiple gates [
[4]
], measuring MES in a sitting position [
[5]
], the addition of blood and increased agitation of the mixture [
[6]
], or the use of galactose based contrast agent during Valsalva's maneuver [
[7]
], may all enhance sensitivity of the detection of RLS. All these methods achieve a
detection of RLS with slightly different degrees of excellence and a good correlation
with transesophageal echocardiography. However, as Sharma et al. point out, there
exists actually no widely accepted protocol for the “best” procedure.To read this article in full you will need to make a payment
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References
- Transforaminal Doppler: an alternative to transtemporal approach for right-to-left cardiac shunt assessment.J Neurol Sci. 2008; 273: 49-50
- Diagnosis of right-to-left shunt with transcranial Doppler and vertebrobasilar recording.Stroke. 2007; 38: 2254-2256
- Can a peripheral artery be used to detect venous-to-arterial circulation shunts?.Cerebrovasc Dis. 2007; 25: 111-114
- Power M-mode transcranial Doppler for diagnosis of patent foramen ovale and assessing transcatheter closure.J Neuroimaging. 2004; 14: 342-349
- Effect of body positioning during transcranial Doppler detection of right-to-left shunts.Eur J Neurol. 2007; 14: 1035-1039
- Is transcranial Doppler for the detection of venous-to-arterial circulation shunts reproducible?.Cerebrovasc Dis. 2007; 23: 424-429
- Right-to-left shunt assessed by contrast transcranial Doppler sonography: new insights.J Ultrasound Med. 2004; 23: 1475-1482
Article info
Publication history
Published online: February 04, 2009
Accepted:
January 6,
2009
Received:
December 28,
2008
Identification
Copyright
© 2009 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
