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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

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Publication Information

Publication Type
Publication Sub Type
Journal Article, Original
Philippine Journal of Cardiology
Publication Date
January-June 2013


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 a 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.

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LocationLocation CodeAvailable FormatAvailability
Philippine Council for Health Research and Development Library Box No. 43 Fulltext Print Format
Philippine Heart Association Fulltext (Download)

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