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Transient Ischemic Attack after Air-Contrast Echocardiography
- T. Narain Srivastava, MD; and
- Eric K. Undesser, MD, PhD
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IN RESPONSE:
We are not surprised that others have shared our experience of symptomatic air embolism after air-contrast echocardiography. Obvious cerebral symptoms such as hemiparesis are difficult to overlook. More subtle symptoms, such as the numbness and paresthesias experienced by our third patient, are likely to go unrecognized. We are surprised that such symptoms are not mentioned more frequently in the literature.
We agree with Dr. Dittrich that patients with larger defects and greater right-to-left heart shunting are probably at greatest risk. Poor cardiac contractility may allow coalescence of air contrast from smaller defects and can also produce symptoms. We also point out that although microcavitation minimizes the risk for symptoms associated with echocardiography, no such protection is afforded from air bubbles trapped within poorly flushed intravenous lines. The use of alternate contrast agents such as Albunex will further minimize risk in patients having contrast echocardiography, but attention to technique remains warranted in the placement of any intravenous line.
T. Narain Srivastava, MD
Eric K. Undesser, MD, PhD
Veterans Affairs Medical Center; Jackson, MS 39216
- Copyright ©2004 by the American College of Physicians
