The Research Of Incidence And Feature Of Right-to-left Shunt In Normal Population And Optimal Posture Choice By TCD

Objective:To observe the incidence, shunt volume, shunt type of normal population,and compare RLS feature between two age groups. To investigate in whichposture can best detect patient RLS by contrast-enhanced transcranial Doppler.Method:1. Collect normal people clinical data volunteering cTCD in the firsthospital of jilin university. According to age,18to45years old in young group,more than45years old in middle age group. Take elbow intravenous injectionactivating the physiological saline as a contrast agent, and combined withValsalva, mpTCD monitoring diagnosis RLS, grade and analysis thedistribution characteristics of different shunt volume and shunt type in thestudy people crowd.2. Collect between August2013and November2013consecutive patientsclinical data examined in the first hospital of jilin university. Each patientunderwent three different postures to detect RLS by cTCD at normal breathingand after Valsalva maneuver: supine, left lateral decubitus, and upright sitting,in a randomized order.Results:1. A total of195cases of normal people into groups, RLS rate was28.7%(56/195), no shunt139cases (71.3%), mionr shunt39cases (20%), mediumshunt7cases (3.6%), a large number of shunt10cases (5.1%). Among56cases RLS positive objectives, inherent type34cases(60.7%), potential type22cases(39.3%).Young group135cases, female81cases (60%), age34.0±7.7; Middle age group60cases, female33cases (55%), age52.7±5.2. Young group RLSrate28.9%(39/135), middle age group RLS rate28.3%(17/60), there was nosignificant difference (p>0.05).Among135cases young group, no shunt96cases (71.1%), mionr shunt28cases (20.7%), medium shunt4cases (3.0%), a large number of shunt7cases (5.2%); Among60cases middle age group, no shunt43cases (71.7%),mionr shunt11cases (18.3%), medium shunt3cases (5.0%), a large numberof shunt3cases (5.0%). shunt volume distribution is no statistical differentbetween two groups(p>0.05), and are mainly mionr shunt.Among39cases RLS positive young group, inherent type25cases(64%), potential type14cases (35.9%); Among17cases RLS positive middleage group, inherent type9cases (52.9%), potential type8cases (47.1%),shunt type distribution is no statistical different between two groups (p>0.05).2. At normal breathing, the RLS positive rates were15.4%,23.1%and28.2%for supine, left lateral decubitus and upright sitting, respectively. AfterValsalva maneuver, the positive rates were25.6%,28.2%and36.8%,respectively. In each posture, with normal breathing the RLS positive rateswere higher than after Valsalva maneuver (15.4%vs.25.6%，p=0.001;23.1%vs.28.2%，p=0.002;28.2%vs.36.8%，p=0.014).Whether normal breathing or Valsalva maneuver, in left lateral decubitusand upright sitting the RLS positive rates were higher than in supine (normalbreathing,23.1%vs.15.4%p=0.011,28.2%vs.15.4%p=0.001; Valsalvamaneuver,28.2%vs.25.6%p=0.007,36.8%vs.25.6%p=0.002), left lateraldecubitus and upright sitting demonstrated no statistical significance (normalbreathing,23.1%vs.28.2%p=0.221; Valsalva maneuver,28.2%vs.36.8%p=0.233).A mild RLS was detected in13/117(11.1%) patients in supine, normal breathing;20/117(17.1%) in supine, VM;20/117(17.1%) in left lateraldecubitus, normal breathing;18/117(15.4%) in left lateral decubitus, VM;22/117(18.8%) in upright sitting, normal breathing;27/117(23.1%) in uprightsitting,VM. A moderate RLS was detected in4/117(3.4%) patients in supine,normal breathing;6/117(5.1%) in supine, VM;2/117(1.7%) in left lateraldecubitus, normal breathing;2/117(1.7%) in left lateral decubitus, VM;7/117(6.0%) in upright sitting, normal breathing;5/117(4.3%) in upright sitting,VM.A large RLS was detected in1/117(0.9%) patients in supine, normal breathing;4/117(3.4%) in supine, VM;5/117(4.3%) in left lateral decubitus, normalbreathing;13/117(11.1%) in left lateral decubitus, VM;4/117(3.4%) in uprightsitting, normal breathing;11/117(9.4%) in upright sitting, VM. None showed astatistically significant difference in shunt grade distribution (p>0.05).Conclusion:1. The incidence of RLS in the selected crowd is about28.7%, and majorsin mionr shunt. RLS incidence, shunt volume and shunt type make nodifference between young group and middle age group.2. The VM can significantly improve the positive rate detection of RLS;different postures can improve RLS positive rate. None showed a statisticallysignificant difference in shunt grade distribution.