Agitated saline test(pulmonary AVM)

UPDATED 2017/08/14

Under supine position, echocardiogram with apical four chamber view and EKG were monitored. Then 8 ml of agitated saline was injected via right/left brachial venous line for 2 times. Multiple bubbles were noted in left atrium within ___(>5) heart beats after apperance in right atrium, compatible with intrapulmonary shunt. Besides, multiple subpleural nodules with swirl vascularization were noted, compatible with pulmonary arteriovenous malformation (PAVM). The patient tolerated the whole procedure well. (DOC____)

 

Protocol:

View: Apical four chamber

Contrast agent preparation:

Subjects are instrumented with an intravenous catheter (i.v.) in a peripheral vein for the introduction of the contrast agent, which is normally air and sterile saline. Typically, 0.5-1 ml of air and 4-10 ml of saline are used to manually agitate between two syringes connected by stopcocks for a total injection volume of 10 ml.

Diagnosis criteria:

Bubbles in left atrium	Meaning	DDx	Reference
<=3 heart beats	Intra-cardiac shunt	PFO, ASD, VSD	Meltzer et al., 1980a; Woods & Patel, 2006
>3 heart beats	Intra-pulmonary shunt	PAVM, PAVA	Nanthakumar et al., 2001; Lee et al., 2003; van Gent et al., 2009; Elliott et al., 2011a
None	Normal