Vol. 41 | No. 1 | January-June 2013 Back

Open Access

Comparison of Micro-bubble Hang-out Time and Cardiac Catheterization in Determining Reversal of Pulmonary Vascular Resistance by Oxygen Challenge Test Among Patients with Shunt Anomalies: The BUBBLE Study

Maria Johanna Matheu-Jaluague, Mary Ong-Go, Francisco Emilio C. Remotigue Jr, Efren R. Vicaldo, Juliet J. Balderas, Romeo J. Santos
Jun 2013 DOI 10.69944/pjc.15532d9103

Abstract

OBJECTIVES: To determine the utility of micro-bubble hang-out time (MHT) in determining reversal of pulmonary vascular resistance (PVR) by oxygen challenge test among patients with shunt anomalies. 

METHODS: This is a cross-sectional study involving 16 in-patients aged older than 14 years, with an isolated shunt anomaly, a pulmonary artery pressure of greater than 60 mmHg who underwent a hemodynamic study (HS). Agitated saline was injected intravenously before and after an oxygen challenge. MHT in the right sided chambers was measured in seconds using the apical 4-chamber view. Patient then had a HS within 24 hours, determining PVR and reversibility. Non-invasive and invasive parameters were then correlated. 

RESULTS: Thirteen patients were found to have reversible PVR as determined by HS (pre-oxygen MHT of 76.36 s ± 25.35 and post-oxygen MHT of 37.18 s ± 15.04; p=0.001), and three patients had irreversible PVR (pre-oxygen MHT of 158.37 s ± 120.41 and post-oxygen MHT of 108.82 ± 80.17; p=0.167). A 60-s cut-off for post-oxygen MHT in determining reversibility had a 100% sensitivity, specificity, and positive and negative predictive values (Kappa=1.000). 

CONCLUSION: A post-oxygen MHT cut-off of 60 s, independent of the pre-oxygen MHT, can be used as an alternative to an HS in labeling patients with isolated shunt anomalies and moderate to severe pulmonary hypertension, into those with reversible (≤ 60 s) and irreversible (> 60 s) PVR. 

KEYWORDS: Contrast, bubble study, hang-out time, pulmonary vascular resistance, pulmonary hypertension, congenital heart disease, shunts.

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