Saturday, January 07, 2006

Menstrual cycle dependent right-to-left shunting: A single-blinded transcranial Doppler sonography study. UHM 2005: VOL 32, ISSUE #6

Menstrual cycle dependent right-to-left shunting: A single-blinded transcranial Doppler sonography study. S.Klien, M. Spiege, K. Engelhard, C. Schmidaue, H. Ulme, M.Dieper, T. Mutzbaue, E. Schmutzhard

Abstract:

Background and purpose:
Menstruation has been described as risk factor for neurological decompression sickness in divers.In considering this for paradoxical gas embolism, we hypothesized that there may be a link between cycle-dependent hormonal changes and the manifestation of a right-to-left shunt (RLS).

Methods:
40 women with a regular cycle of 28 days underwent transcranial Doppler sonography examinations (TCD) on day 1 and on day 15 of the menstrual cycle. Cerebral high intensity transient signs (HITS) proved a RLS.

Results:
We found a 25% RLS incidence consistent with the literature. In 7 of 10 shunt positive women it was detected mainly or exclusively on day 15. This difference in PFO detection rate is statistically signi´Čücant (p=0.031),indicating more RLS during the peri-ovulatory period.

Conclusions:
Our results do not support menstruation as a risk factor for neurological decompression sickness. The peri-ovulatory estrogen peak, which leads to systemic vasodilation, may explain our data.Factors that increase the risk for developing a RLS and thereby paradoxical embolism should be avoided, perhaps including diving during the peri-ovulatory period of the menstrual cycle. Furthermore, contrast PFO testing in fertile females may be most sensitive if conducted mid-cycle.

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