Objective:To explore the clinical value of transesophageal echocardiography combined with right heart acoustic contrast(c-TEE)in detecting pulmonary arteriovenous shunt(P-RLS).Methods:A total of 1893 patients who underwent transesophageal echocardiography for different etiologies were evaluated for P-RLS by performing inferior right esophageal echocardiography.Results:Among 1893 patients,a total of 1524 patients had P-RLS(80.5％),including 812 cases of grade 1 in P-RLS,413 cases of grade 2,and 299 cases of grade 3.The 342 patients underwent pulmonary artery CTA examination,and 71 patients underwent both pulmonary artery CTA and pulmonary angiography examination.A total of 14 cases(0.9％)of pulmonary arteriovenous fistula were detected.In addition,1125 patients had right to left shunt of patent foramen ovale(PFO-RLS),accounting for 73.8％.The 826 patients had both PFO-RLS and P-RLS(54.2％),and 698 patients had simple P-RLS(45.8％).There were no significant statistical differences in gender,age,height,weight,underlying diseases,smoking his-tory,and alcohol consumption history between P-RLS patients and without P-RLS patients.According to the presence of neurological complications(NC)related to right to left shunt(RLS),there was no significant difference in the detection rates of PFO-RLS and total P-RLS between the RLS-NC group and the control group.The inci-dence of grade 3 in P-RLS in the RLS-NC group was higher than that in the control group(P=0.033),and the in-cidence of grade 1 P-RLS was lower than that in the control group(P=0.021).There is a significant correlation between P-RLS grade 3 and NC(migraine,unexplained stroke,syncope)(OR=3.794;95％CI1.054-13.653;P=0.041).Conclusion:c-TEE can detect whether it is diversion of PFO or P-RLS.The incidence of P-RLS is high,and P-RLS grade 3 is associated with NC.
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