Detection of intracardiac left-to-right shunting in adults: A prospective analysis of the variability of the standard indocyanine green technique in patients without shunting

Elaine H. Niggemann, T. S. Patrick, Kenneth P. Sunnergren, Michael D. Winniford, L. David Hillis

Research output: Contribution to journalArticle

7 Scopus citations

Abstract

Intracardiac left-to-right shunting may be detected and quantitated by an oximetric analysis of blood from the right-sided cardiac chambers and prominent early recirculation of indocyanine green after it is injected into the central venous circulation and sampled from a systemic artery. Although the variability of oximetric measurements has been established in patients without shunting and a range of normal has been determined for the technique, the variability of the indocyanine green method among persons without shunting has not been clarified; as a result, a range of normal for indocyanine green has not been established. In 66 adult patients in whom hydrogen inhalation (an extremely sensitive technique for detecting even very small intracardiac left-to-right shunts) revealed no shunting, indocyanine green curves were generated by injection into the pulmonary artery as blood was sampled from a systemic artery. In these patients the percentage left-to-right shunt (that is, the percentage of pulmonary blood flow reaching the lungs through an intracardiac shunt) (determined with the equation of Carter et al) ranged from -9% to +26% (+7 ± 8%, mean ± standard deviation). There was no definable relation between the percentage left-to-right shunt and the indicator dilution measurement of cardiac output. Thus, these data establish a range of normal for the indocyanine green technique of detecting and measuring intracardiac left-to-right shunting. If this technique is to be used reliably to detect shunting, its results must demonstrate a percentage shunt in excess of +26%.

Original languageEnglish (US)
Pages (from-to)355-357
Number of pages3
JournalThe American journal of cardiology
Volume60
Issue number4
DOIs
StatePublished - Aug 1 1987

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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