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A cardiac diagnosis by contrast echocardiography
  1. Jasper J Brugts,
  2. Michelle Michels,
  3. Corstiaan A den Uil
  1. Department of Cardiology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Dr Jasper J Brugts, Department of Cardiology, Erasmus MC Thoraxcenter, ‘s Gravendijkwal 230, Rotterdam 3015CE, The Netherlands;j.brugts{at}erasmusmc.nl

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Introduction

A middle-aged patient with a history of smoking and alcoholic liver cirrhosis was screened for liver transplantation. He had dyspnea on exertion. The EKG and chest X-ray revealed no abnormalities. Pulmonary function tests showed moderate obstruction. Arterial blood gas analysis revealed hypoxemia (saturation 89%) without significant orthodeoxia. On a 6 min walk test, saturation decreased to 82%. The AA-gradient was elevated (8.4 kPa). CT did not show any arteriovenous communications. Intrapulmonary shunting measured by conventional oxygen method and confirmed by radionuclide imaging was 19%. Transthoracic echocardiography demonstrated normal left and right ventricular size and function, mitral …

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