{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T20:45:12Z","timestamp":1769114712736,"version":"3.49.0"},"reference-count":44,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2016,2,4]],"date-time":"2016-02-04T00:00:00Z","timestamp":1454544000000},"content-version":"vor","delay-in-days":6792,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Journal of Neuroimaging"],"published-print":{"date-parts":[[1997,7]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Transcranial Doppler sonography (TCD) is a simple method to detect a right\u2010to\u2010left cardiac shunt, although standardized procedures do not exist. In this study 69 patients were tested according to predetermined criteria and procedures (cluster of &gt; 10 microbubbles, duration between injection in the cubital vein and detection in the middle cerebral artery [MCA] \u2264 10 sec). Agitated saline solution was compared to oxypolygelatine, a plasma volume expander, as contrast media. Valsalva's maneuver and coughing were used to provoke right\u2010to\u2010left cardiac shunting, detected by TCD, transthoracic echocardiography (TTE), and transesophageal echocardiography (TEE). Oxypolygelatine caused a significantly higher number of microbubbles in the right atrium and MCA than did the saline solution, leading to a greater diagnostic reliability of TCD (paired t test, <jats:italic>p<\/jats:italic> &lt; 0.001). Coughing did not provoke right\u2010to\u2010left cardiac shunts (\u03c7<jats:sup>2<\/jats:sup> analysis, <jats:italic>p<\/jats:italic> &lt; 0.001). The technique used for carrying out Valsalva's maneuver was important for the detection of right\u2010to\u2010left cardiac shunts. Twenty\u2010five right\u2010to\u2010left shunts were diagnosed with TCD and 18 with TTE (36 vs 26%; \u03c7<jats:sup>2<\/jats:sup> analysis, <jats:italic>p<\/jats:italic> = 0.1). The findings indicate that TCD when properly done is highly sensitive and specific for the diagnosis of right\u2010to\u2010left cardiac shunts.<\/jats:p>","DOI":"10.1111\/jon199773159","type":"journal-article","created":{"date-parts":[[2016,2,8]],"date-time":"2016-02-08T10:30:16Z","timestamp":1454927416000},"page":"159-163","source":"Crossref","is-referenced-by-count":23,"title":["Optimized Transcranial Doppler Technique for the Diagnosis of Cardiac Right\u2010to\u2010Left Shunts"],"prefix":"10.1111","volume":"7","author":[{"given":"A.","family":"Albert,","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"H. 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