探讨不同右心房增压方式应用于经胸右心声学造影（C-TTE）评估卵圆孔未闭（PFO）隐匿性右向左分流（RLS）的价值。

回顾性选取2019年6月至2020年6月在四川省人民医院行C-TTE检查的患者70例。所有患者均经手术或经食管超声心动图（TEE）确诊为PFO。所有患者静息状态下C-TTE均为阴性，然后依次完成了用力咳嗽（CH）、有效Valsalva动作（SVM）、有效Valsalva动作放松即刻用力咳嗽（SVM-CH）3种右心房增压方式，且至少有1种增压方式激发出RLS。比较不同增压方式对PFO隐匿性RLS的检出率，并与TEE进行对比分析。

CH、SVM、SVM-CH 3种增压方式和CH+SVM、SVM+SVM-CH 2种增压方式联合应用，C-TTE对PFO隐匿性RLS的检出率分别为71.43%、95.71%、81.43%、97.14%、100%，对大量RLS的检出率分别为10.00%、54.28％、35.71％、55.72％、71.43％。CH、SVM、SVM-CH、CH+SVM、SVM+SVM-CH对无、少量、中量、大量RLS检出率的比较，总体差异有统计学意义（χ²=37.771，P＜0.001）。70例中有34例进行了TEE检查，SVM+SVM-CH联合增压方式下C-TTE对PFO隐匿性RLS的检出率（100%，34/34）高于TEE的检出率（82.35%，28/34）。34例中SVM-CH检出而SVM未检出RLS者3例，此3例TEE均显示为长裂隙样PFO。

SVM和SVM-CH两种增压模式联合应用有助于提高C-TTE对PFO隐匿性RLS的检出率，且C-TTE配合右心房增压方式的合理选择对于PFO隐匿性RLS的检出率优于TEE。

To compare the effects of different right atrial pressurization methods on the detection of occult right to left shunt (RLS) of patent foramen ovale (PFO) by contrast transthoracic echocardiography (C-TTE), in order to improve the detection sensitivity of C-TTE.

A retrospective analysis was performed on 70 patients with PFO diagnosed by surgery or esophageal echocardiography at Sichuan Provincial People's Hospital from March 2019 to July 2020. All patients had negative C-TTE results in the resting state in the right heart. At the same time, all patients completed three right atrial pressurization methods: cough hard (CH), successful Valsalva maneuver (SVM), and SVM immediately followed by CH (SVM-CH). The effects of the three pressurization methods on the detection of RLS by SVM-CH were compared.

We applied three right atrial pressurization modes (CH, SVM-CH, SVM) and two combined modes (SVM and CH, SVM and SVM-CH) for C-TTE detection of PFO occult RLS. The detection rates were 71.43%, 95.71%, 81.43%, 97.14%, and 100%, respectively, and the detection rates for large RLS were 10.00%, 54.28%, 35.71%, 55.72%, and 71.43%, respectively. CH, SVM-CH, SVM, CH and SVM, SVM and SVM-CH were used for C-TTE, respectively, and the overall difference in the quantification of RLS was statistically significant (χ²=37.771, P＜0.001). Thirty-four of the 70 patients underwent transesophageal echocardiography (TEE). SVM and SVM-CH were used to increase the right atrial pressure for C-TTE, and the detection rate of occult RLS by C-TTE (100%, 34/34) was higher than that by TEE (82.35%, 28/34). Among the 34 patients, C-TTE was detected by SVM-CH, but not by SVM in three cases, all of which showed long fissure PFO on TEE.

Using SVM and SVM-CH to increase the right atrial pressure for C-TTE is helpful to improve the detection rate of PFO occult RLS by C-TTE, and the detection rate for PFO occult RLS by C-TTE combined with reasonable right atrial pressurization mode is better than TEE.