1
|
Frinking P, Segers T, Luan Y, Tranquart F. Three Decades of Ultrasound Contrast Agents: A Review of the Past, Present and Future Improvements. ULTRASOUND IN MEDICINE & BIOLOGY 2020; 46:892-908. [PMID: 31941587 DOI: 10.1016/j.ultrasmedbio.2019.12.008] [Citation(s) in RCA: 131] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Revised: 12/05/2019] [Accepted: 12/06/2019] [Indexed: 06/10/2023]
Abstract
Initial reports from the 1960s describing the observations of ultrasound contrast enhancement by tiny gaseous bubbles during echocardiographic examinations prompted the development of the first ultrasound contrast agent in the 1980s. Current commercial contrast agents for echography, such as Definity, Optison, Sonazoid and SonoVue, have proven to be successful in a variety of on- and off-label clinical indications. Whereas contrast-specific technology has seen dramatic progress after the introduction of the first approved agents in the 1990s, successful clinical translation of new developments has been limited during the same period, while understanding of microbubble physical, chemical and biologic behavior has improved substantially. It is expected that for a successful development of future opportunities, such as ultrasound molecular imaging and therapeutic applications using microbubbles, new creative developments in microbubble engineering and production dedicated to further optimizing microbubble performance are required, and that they cannot rely on bubble technology developed more than 3 decades ago.
Collapse
Affiliation(s)
- Peter Frinking
- Tide Microfluidics, Capitool 41, Enschede, The Netherlands.
| | - Tim Segers
- Physics of Fluids group, University of Twente, Enschede, The Netherlands
| | - Ying Luan
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
| | - François Tranquart
- R&D Pharmaceutical Diagnostics, General Electric Healthcare, Amersham, UK
| |
Collapse
|
2
|
Biagi E, Breschi L, Vannacci E, Masotti L. Stable and transient subharmonic emissions from isolated contrast agent microbubbles. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2007; 54:480-97. [PMID: 17375818 DOI: 10.1109/tuffc.2007.272] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Ultrasound contrast agents (UCAs) have been widely studied in recent years in order to improve and develop new, sophisticated imaging techniques for clinical applications. In order to improve the understanding of microbubble-ultrasound interactions, an acoustic dynamic characterization of UCA microbubble behavior was performed in this work using a high frame-rate acquiring and processing system. This equipment is connected to a commercial scanner that provides RF beam-formed data with a frame-rate of 30 Hz. Acquired RF sequences allows us to follow the dynamics of cavitation mechanisms in its temporal evolution during different insonifying conditions. The experimental setup allowed us to keep the bubbles free in a spatial region of the supporting medium, thus avoiding boundary effects that can alter the ultrasound field and the scattered echo from bubbles. The work focuses on the study of subharmonic emission from an isolated bubble of contrast agent. In particular, the acoustic pressure threshold for a subharmonic stable emission was evaluated for a subset of 50 microbubbles at 3.3 MHz and at 5 MHz of insonation frequencies. An unexpected second pressure threshold, which caused the stand still of the subharmonic emission, was detected at 3.3 MHz and 5 MHz excitation frequencies. A transient subharmonic emission, which is hypothesized as being related to the formation of new free gas bubbles, was detected during the ultrasound-induced destruction of microbubbles. An experimental procedure was devised in order to investigate these behaviors and several sequences of RF echo signals and the related spectra, acquired from an isolated bubble in different insonation conditions, are presented and discussed in this paper.
Collapse
Affiliation(s)
- Elena Biagi
- University of Florence, Department of Electronics and Telecommunications, Firenze, Italy
| | | | | | | |
Collapse
|
3
|
Padial LR, Chen MH, Vuille C, Guerrero JL, Weyman AE, Picard MH. Pulsatile pressure affects the disappearance of echocardiographic contrast agents. J Am Soc Echocardiogr 1995; 8:285-92. [PMID: 7640022 DOI: 10.1016/s0894-7317(05)80039-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
The purpose of this study was to determine in an in vitro model the effect of pulsatile pressure on the decay of echocardiographic contrast agents. Use of contrast agents for quantitative assessment of perfusion requires understanding of the factors controlling their rates of disappearance. Prior studies have shown that constant pressure affects the rate of disappearance of these agents. It is not known whether pulsatile pressure influences the rate of decay of contrast agents. In an in vitro chamber, three contrast agents (Albunex, hand-agitated saline solution, and hand-agitated Angiovist) were exposed to pulses of pressure at three rates (30, 60, and 120 pulsations/min), keeping pressure characteristics (peak, nadir, and mean) within a narrow range. Five injections were performed for each agent at each rate. Two-dimensional echocardiographic images of the effects of contrast material were recorded from injection until total disappearance. Videointensity was measured and time-intensity curves were generated. These curves of intensity decay were fitted to an exponential decay function (I = Ae-lambda t) and the velocity of decay (lambda) was used for comparisons. For all agents, intensity of contrast decreased over time. Saline solution and Angiovist, but not Albunex, showed pulsatile decreases in intensity of contrast with each peak pressure and partial recovery of contrast intensity with each nadir pressure. (ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- L R Padial
- Cardiac Unit, Massachusetts General Hospital, Boston 02114, USA
| | | | | | | | | | | |
Collapse
|
4
|
Frazin LJ, Vonesh MJ, Yaacoub AS, Kane BJ, Greene R, Kemper WS, Guberek M, McPherson DD. Doppler catheter tip localization using color enhancement. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1994; 32:62-9. [PMID: 8039223 DOI: 10.1002/ccd.1810320115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
The objective of this research was to determine if the ultrasound emissions of the Doppler catheter can be used to locate its position in 3 dimensions by conventional echocardiography. A Doppler catheter has previously been shown to permit nonfluoroscopic retrograde catheterization of the aortic root and left ventricular chamber by using velocity waveform polarity for directional guidance. A significant difficulty in providing ultrasound catheter guidance, however, has been the inability to recognize the Doppler catheter tip, because each point at which a flexible catheter crosses the image plane can be misinterpreted as the catheter tip. Initial in vitro water bath trials were performed using the Doppler catheter attached to a standard velocimeter. Using a 5 MHz imaging transducer and color Doppler methods, the presence or absence of a banded color pattern which could demarcate the Doppler catheter tip was recorded at various angles in and out of the scanning plane. Using Doppler retrograde guidance and transesophageal echocardiography, color Doppler banded patterns, which could identify the Doppler catheter tip, were investigated in the dog aorta. In order to understand the physical mechanisms involved, a series of water bath trials were then conducted using the Doppler catheter attached to a velocimeter which was synchronized to the echo machine. Initial nonsynchronized water bath trials revealed distinct banded color patterns demarcating the Doppler catheter tip when it pointed in any direction within the beam width, except for a 40 degrees blind cone directly away from the imaging transducer.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- L J Frazin
- Department of Medicine, Northwestern University, Chicago, Illinois 60611
| | | | | | | | | | | | | | | |
Collapse
|
5
|
Goldberg BB, Liu JB, Forsberg F. Ultrasound contrast agents: a review. ULTRASOUND IN MEDICINE & BIOLOGY 1994; 20:319-33. [PMID: 8085289 DOI: 10.1016/0301-5629(94)90001-9] [Citation(s) in RCA: 294] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/03/2023]
Abstract
During the past 25 years, many attempts have been made to establish effective ultrasound contrast agents for both cardiac and noncardiac applications. The ideal ultrasound contrast agent would be: (a) nontoxic; (b) injectable intravenously; (c) capable of passing through the pulmonary, cardiac and capillary circulations; and (d) stable for recirculation. A variety of potential ultrasound contrast agents have been or are now under development. Present and future ultrasound contrast agents should provide for increased diagnostic capabilities in a variety of normal and abnormal vessels and organs throughout the body. These agents will enhance tumor vascularity, delineate areas of ischemia, as well as improve visualization of vascular stenosis. Future developments with modification of ultrasound equipment should increase the capabilities of these agents to improve imaging as well as Doppler sensitivity.
Collapse
Affiliation(s)
- B B Goldberg
- Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, PA
| | | | | |
Collapse
|
6
|
Wiencek JG, Feinstein SB, Walker R, Aronson S. Pitfalls in quantitative contrast echocardiography: the steps to quantitation of perfusion. J Am Soc Echocardiogr 1993; 6:395-416. [PMID: 8217207 DOI: 10.1016/s0894-7317(14)80239-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Current methods used clinically to assess myocardial perfusion are invasive and expensive. As the technology of ultrasound imaging improves, CE may provide a relatively inexpensive, noninvasive means of quantitating myocardial perfusion. Issues regarding stability of microbubble contrast agents must be studied more closely under physiologic conditions. As such, encapsulated microbubbles may provide more stability under physiologic pressures than free gas microbubbles. Introducing high concentrations of contrast, either by hyperconcentrating the contrast agent or by increasing the injection rate, may provide greater stability under physiologic conditions. Further, before quantitative statement of tissue perfusion can be made, the relationship between tracer concentration and system response must be established. Further, a "linear" postprocessing ultrasound setting does not eliminate this requirement as data must still undergo nonlinear transformation during log compression and time-gain compensation. Additionally, issues regarding "electronic thresholding" must be explored more extensively in vivo. Commercial ultrasound scanners, in their present form, may not offer adequate sensitivity for absolute quantitative studies. Further development of modified ultrasound systems may provide sufficient sensitivity for quantitative perfusion imaging. CE offers a potentially powerful tool in the clinical management of patients with ischemic heart disease. Conventional coronary angiography provides information on the size of a lesion, but accompanying tissue perfusion distal to the lesion cannot be determined. Doppler ultrasonography determines velocity of blood flow in large vessels but does not offer the potential to quantitate tissue perfusion. Clearly, CE has a place in the future of diagnostic imaging. The recent work of Ito et al. demonstrated the qualitative potential of CE in the identification of "areas at risk" in patients who had undergone thrombolysis or percutaneous transluminal coronary angioplasty after an acute myocardial infarction. With further improvement in the ultrasound imaging techniques and microbubble stability, CE may offer an inexpensive, noninvasive means of assessing myocardial perfusion.
Collapse
Affiliation(s)
- J G Wiencek
- University of Chicago, Pritzker School of Medicine, IL
| | | | | | | |
Collapse
|
7
|
Sutherland GR. Has echo/Doppler influenced the practice of paediatric cardiology? INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1993; 9 Suppl 2:17-26. [PMID: 8409549 DOI: 10.1007/bf01143176] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- G R Sutherland
- Department of Cardiology, Western General Hospital, Edinburgh, Scotland
| |
Collapse
|
8
|
Heidenreich PA, Wiencek JG, Zaroff JG, Aronson S, Segil LJ, Harper PV, Feinstein SB. In vitro calculation of flow by use of contrast ultrasonography. J Am Soc Echocardiogr 1993; 6:51-61. [PMID: 8439423 DOI: 10.1016/s0894-7317(14)80256-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
Contrast echocardiography has been used for qualitative assessment of cardiac function, and its potential for quantitative assessment of blood flow is being explored. With the development of an ultrasound contrast agent capable of passage through the microcirculation, a mathematical model based on classic dye dilution theory, and a digital ultrasound acquisition system, absolute quantitation of myocardial perfusion may be feasible. This study validates the mathematical model in a simple in vitro tube system. Flow was delivered at variable rates through an in vitro tube system while a longitudinal section was imaged with a modified commercial ultrasound scanner. Albunex contrast agent was injected, and videointensity data were captured and analyzed off line. Time-intensity curves were generated, and flow was calculated by use of a mathematical model derived from classic dye dilution mathematics. For 39 different flow rates, ranging for 9.2 to 110 ml/seconds, a correlation coefficient of r = 0.928 (p < 0.001) with a slope of 0.97 was calculated. We conclude that (1) contrast ultrasonography is capable of quantitative determination of flow in an in vitro system, and (2) a mathematical model based on dye dilution theory can be used to calculate flow with accuracy and precision.
Collapse
Affiliation(s)
- P A Heidenreich
- Department of Medicine, University of California, San Francisco
| | | | | | | | | | | | | |
Collapse
|
9
|
Dent JM, Jayaweera AR, Glasheen WP, Nolan SP, Spotnitz WD, Villanueva FS, Kaul S. A mathematical model for the quantification of mitral regurgitation. Experimental validation in the canine model using contrast echocardiography. Circulation 1992; 86:553-62. [PMID: 1638721 DOI: 10.1161/01.cir.86.2.553] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
BACKGROUND Because the clearance of contrast from the left atrium (LA) relative to the left ventricle (LV) depends on the degree of mitral regurgitation (MR), we hypothesized that a mathematical model can be developed that would provide a quantitative estimation of MR from the washout of contrast from these chambers. METHODS AND RESULTS After mathematically developing the model, we performed experiments in two groups of dogs with the use of contrast echocardiography. Group 1 consisted of nine dogs in which different degrees of MR were produced by creating ischemic LV dysfunction. Contrast was injected into the LV, and MR was graded visually on a scale of from 0 to 4+. Videointensity plots generated from the LA and LV were provided to the model. There was excellent correlation between visual assessment of MR and model-derived regurgitant fraction in the 33 stages: y = 0.16x + 0.002 (r = 0.97, p less than 0.001, SEE = 0.06). To obtain a more quantitative validation, we placed electromagnetic flow probes on the aorta and just cephalad to the mitral annulus in six dogs (group 2) during cardiopulmonary bypass. Different degrees of MR were produced by chordal traction and/or myocardial ischemia. Regurgitant fraction was calculated at each stage from the flow probe and videointensity data. There was excellent correlation between flow probe and model-derived regurgitant fraction (y = 0.90x + 0.03; r = 0.96, p less than 0.001, SEE = 0.06), and close interobserver and intraobserver correlations were noted using flow probe and contrast echocardiographic data. CONCLUSIONS A mathematical model that uses the clearance of contrast from the LA relative to the LV can be used to accurately measure the severity of MR. These findings may have important practical implications for the quantification of MR.
Collapse
Affiliation(s)
- J M Dent
- Department of Medicine, University of Virginia School of Medicine, Charlottesville
| | | | | | | | | | | | | |
Collapse
|
10
|
Frazin LJ, Vonesh MJ, Khasho F, Lanza G, Chandran KB, Talano JV, McPherson DD. A Doppler guided retrograde catheterization system. CATHETERIZATION AND CARDIOVASCULAR DIAGNOSIS 1992; 26:41-50; discussion 50-2. [PMID: 1499062 DOI: 10.1002/ccd.1810260110] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
A Doppler guided retrograde catheterization system was developed to accurately catheterize the aortic root and left ventricular chamber without X-ray. This system consists of a 20 MHz, 0.076 mm thick x 1.016 mm diameter pulsed Doppler crystal integrated into the tip of a 100 cm multipurpose triple lumen catheter. Two lumens (0.61 mm) are used for electrodes; a third lumen (1.245 mm) may be used for guidewire and pressure determination; and the system is attached to a flow velocimeter. In an aortic arch flow model, the principles of Doppler signal guidance were confirmed with flow toward the catheter tip demonstrating positive signals and flow away from the catheter tip demonstrating negative signals. The magnitude and polarity (direction) of the detected phasic and mean velocities were utilized to guide catheterization in six dogs. Using the reversal of Doppler signal polarity to indicate branch entry and manipulating the catheter so as to maintain maximal positive axial velocity, the Doppler catheter was successfully advanced from the femoral artery to the aortic valve. Branches detected by the Doppler system were confirmed by fluoroscopy. The aortic valve was audible when approached and the left ventricular chamber was recognized by its characteristic pressure waveform. The Doppler guided retrograde catheterization system offers new technology to perform left heart catheterization without X-ray and may prove useful in a variety of settings including the development of invasive ultrasonic diagnostic and therapeutic technology.
Collapse
Affiliation(s)
- L J Frazin
- Department of Medicine, Northwestern University, Chicago, Illinois 60611
| | | | | | | | | | | | | |
Collapse
|
11
|
Kotlewski A, Kawanishi D, Rahimtoola SH. Management of valvular heart disease: an illustrative cases approach. Curr Probl Cardiol 1991; 16:1-88. [PMID: 2015774 DOI: 10.1016/0146-2806(91)90003-s] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
As indicated by the 22 illustrative cases included in this monograph, a stepwise approach to the assessment of valvular heart disease provides the information necessary to make good clinical decisions. The ECG and chest x-ray add useful information to the history and physical examination. Echocardiography, Doppler, and color flow Doppler techniques have an important role in defining the presence and severity of valvular stenosis and regurgitation. Nuclear techniques provide useful information about global biventricular systolic function, regional wall motion, and myocardial perfusion. Exercise testing is most valuable in confirming objectively the patient's functional status and exercise tolerance. Newer imaging techniques, such as cine CT and MRI, are capable of displaying and measuring cardiac chamber size and myocardial thickness; however, visualization of the cardiac valves and demonstration of flow abnormalities are difficult, limiting the current usefulness of these techniques in patients with valvular heart disease.
Collapse
Affiliation(s)
- A Kotlewski
- Department of Medicine LAC/USC Medical Center
| | | | | |
Collapse
|
12
|
Smith MD, Elion JL, McClure RR, Kwan OL, DeMaria AN. Left heart opacification with peripheral venous injection of a new saccharide echo contrast agent in dogs. J Am Coll Cardiol 1989; 13:1622-8. [PMID: 2723275 DOI: 10.1016/0735-1097(89)90357-4] [Citation(s) in RCA: 94] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Opacification of the left heart chambers after venous injection of echo contrast agents with transpulmonary capabilities has been difficult to achieve because of a lack of availability of a biodegradable nontoxic agent that produces uniformly small microbubbles. SHU-508 is a new saccharide echo contrast agent that produces bubble sizes from 2 to 8 microns in diameter, capable of traversing the pulmonary capillary bed and resulting in left heart contrast. The echo intensity produced by this agent was compared with that of agitated saline solution, indocyanine green and SHU-454 (another experimental saccharide agent for right-sided contrast) during 136 injections in eight dogs. Videotaped two-dimensional echographic images were digitized and analyzed with the use of videodensitometry for peak right and left ventricular intensity, pulmonary transit times and time of persistence of contrast. The highest right ventricular intensity value (3,594 +/- 1,393) was achieved with SHU-508 (p less than 0.05 compared with the other agents). The right ventricular contrast seen with SHU-508 also persisted for a longer period (22.8 +/- 12 s) than with the standard agents (p less than 0.001). Left ventricular contrast with SHU-508 was visually evident in all 42 injections, whereas the peak left ventricular intensity was 35% as bright as that produced in the right ventricle by the same agent. Peak left ventricular intensity values from SHU-508 were compared with those from agitated saline solution injected from the pulmonary capillary wedge position in four dogs. SHU-508 produced brighter left ventricular intensity (1,281 +/- 607) compared with that obtained with the saline-wedge technique (p les than 0.002).(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
Affiliation(s)
- M D Smith
- Division of Cardiovascular Medicine, University of Kentucky College of Medicine, Lexington 40536-0084
| | | | | | | | | |
Collapse
|
13
|
McKay CR, Waller BF, Hong R, Rubin N, Reid CL, Rahimtoola SH. Problems encountered with catheter balloon valvuloplasty of bioprosthetic aortic valves. Am Heart J 1988; 115:463-5. [PMID: 3341182 DOI: 10.1016/0002-8703(88)90496-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Affiliation(s)
- C R McKay
- Department of Medicine, LAC-USC Medical Center, University of Southern California School of Medicine
| | | | | | | | | | | |
Collapse
|
14
|
Schmid FX, Dahm M, Iversen S, Erbel R, Oelert H. [Assessment of heart valve reconstructive measures using intraoperative transesophageal contrast echocardiography]. LANGENBECKS ARCHIV FUR CHIRURGIE 1987; 372:623-5. [PMID: 3431278 DOI: 10.1007/bf01297897] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
In 30 patients (6 mitral stenoses, 13 mitral insufficiencies, 12 tricuspid insufficiencies) intraoperative transoesophageal contrast echocardiography (TEE) was performed to examine the valve function after AV valve reconstruction. In the beating heart 1 ml of contrast medium was injected into the ventricle to assess the success of valve reconstruction by the extent of regurgitation into the left or right atrium respectively. In all 12 patients successful tricuspid valve reconstruction was detected. In 16/19 cases with mitral valve repair successful reconstruction has been demonstrated. In another 3 patients severe mitral insufficiency after valve repair was detected by TEE, finally intraoperative decision for valve replacement was made.
Collapse
Affiliation(s)
- F X Schmid
- Klinik und Poliklinik für Herz-, Thorax- und Gefässchirurgie, Johannes Guttenberg-Universität, Mainz
| | | | | | | | | |
Collapse
|
15
|
Goldman ME, Guarino T, Fuster V, Mindich B. The necessity for tricuspid valve repair can be determined intraoperatively by two-dimensional echocardiography. J Thorac Cardiovasc Surg 1987. [DOI: 10.1016/s0022-5223(19)36217-8] [Citation(s) in RCA: 45] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|
16
|
Lang RM, Borow KM, Neumann A, Feinstein SB. Echocardiographic contrast agents: effect of microbubbles and carrier solutions on left ventricular contractility. J Am Coll Cardiol 1987; 9:910-9. [PMID: 3558990 DOI: 10.1016/s0735-1097(87)80250-4] [Citation(s) in RCA: 30] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Recently, there has been a resurgence of interest in the use of contrast-enhanced echocardiography as a means of noninvasively assessing myocardial perfusion. However, if injections of echocardiographic contrast agents are to be used for this purpose it is essential that they are not intrinsically toxic to the heart. In this study, the left ventricular end-systolic wall stress-rate-corrected velocity of fiber shortening relation, a load independent index of contractility, was studied in nine dogs. Two-dimensional and targeted M-mode echocardiographic as well as central aortic pressure tracings were made during echocardiographically gated, pressure- and volume-controlled aortic root injections of nonsonicated and sonicated Renografin-76, saline and dextrose 70% (n = 6), and sonicated and hand-agitated Renografin-76/saline mixture (n = 5). Two of nine dogs received all agents. Off-line computer videodensitometric analysis documented myocardial perfusion. In all cases, data were obtained at control and 5 and 15 seconds after injection. Additional data were collected at 25 seconds after injection for the Renografin-76/saline mixture. Alterations in contractility were measured relative to control as changes in rate-corrected velocity of fiber shortening after afterload (measured as end-systolic wall stress) was eliminated as a confounding variable. Under no condition did saline or Renografin-76 cause alterations in left ventricular contractility. Nonsonicated and sonicated dextrose 70% increased left ventricular contractility at 15 seconds but not at 5 seconds after injection. Hand-agitated Renografin-76/saline mixture induced a negative inotropic effect at 5 and 15 seconds after injection.(ABSTRACT TRUNCATED AT 250 WORDS)
Collapse
|
17
|
Powsner SM, Feinstein SB. Quantitative Radiofrequency Analysis of Sonicated Echo Contrast Agents. DEVELOPMENTS IN CARDIOVASCULAR MEDICINE 1987. [DOI: 10.1007/978-94-009-3307-1_2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
|
18
|
|
19
|
MEHLMAN DAVIDJ. Utility of Two-Dimensional and Doppler Echocardiography in Assessing the Etiology and Severity of Mitral Regurgitation. Echocardiography 1986. [DOI: 10.1111/j.1540-8175.1986.tb00189.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
20
|
Drexler M, Erbel R, Dahm M, Mohr-Kahaly S, Oelert H, Meyer J. Assessment of successful valve reconstruction by intraoperative transesophageal echocardiography (TEE). INTERNATIONAL JOURNAL OF CARDIAC IMAGING 1986; 2:21-30. [PMID: 3668299 DOI: 10.1007/bf01553933] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
In 17 patients (10 patients with mitral insufficiency, 5 patients with tricuspid regurgitation, 2 patients with mitral stenosis) the result of valve reconstruction was evaluated by intraoperative two-dimensional transesophageal contrast-echocardiography (TEE). Therefore, 1-2cc of an agitated contrast-medium (Gelifundol) were injected into the left or right ventricle. The result of reconstruction was assessed by the extent of regurgitant microbubbles into the left or right atrium. A successful valve repair could be demonstrated in 15 patients without or with only minimal regurgitation of contrast-fluid. In one patient residual severe mitral insufficiency after valve reconstruction could only be detected when valve function was examined by contrast-TEE in the beating heart. An intraoperative decision for valve replacement was made. In another patient, mild to moderate residual mitral incompetence was shown; no further surgical intervention was done. By TEE the function of reconstructed valves can be examined under physiological conditions in the beating heart. Surgeons can obtain additional intra-operatively information and certainty about the result of reconstruction and an early decision for valve replacement can be made if necessary.
Collapse
Affiliation(s)
- M Drexler
- II. Medical Clinic, Johannes Gutenberg-University, Mainz, FRG
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
Intraoperative two-dimensional echocardiography is a new diagnostic and monitoring technique that provides immediate information, unavailable from routine hemodynamic measurements, on both myocardial and valvular function. The presence and severity of valvular regurgitation can be assessed from the visualized flow pattern of microbubbles generated by an injection of saline solution: reflux flow into the retrograde chamber represents valvular insufficiency. The extent of valvular regurgitation can be determined immediately after conservative valve repair (annuloplasty or commissurotomy) or replacement to avoid the patient's leaving the operating suite with significant but undetected valvular insufficiency. Additionally, intraoperative echocardiography permits rapid evaluation of left ventricular systolic and diastolic volumes and myocardial contractility, thereby facilitating therapeutic interventions in the operating room. It also permits assessment of congenital heart defects and the competency of their repair. Pulsed, continuous and color-flow real time Doppler imaging methods allow further intraoperative definition of stenotic and regurgitant lesions.
Collapse
|
22
|
Skorton DJ, Collins SM, Garcia E, Geiser EA, Hillard W, Koppes W, Linker D, Schwartz G. Digital signal and image processing in echocardiography. The American Society of Echocardiography. Am Heart J 1985; 110:1266-83. [PMID: 4072883 DOI: 10.1016/0002-8703(85)90024-9] [Citation(s) in RCA: 35] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Digital signal and image processing techniques are acquiring an increasingly important role in the generation and analysis of cardiac images. This is particularly true of 2D echocardiography, in which image acquisition, manipulation, and storage within the echocardiograph, as well as quantitative analysis of echocardiographic data by means of "off-line" systems, depend upon digital techniques. The increasing role of computers in echocardiography makes it essential that echocardiographers and technologists understand the basic principles of digital techniques applied to echocardiographic instrumentation and data analysis. In this article, we have discussed digital techniques as applied to image generation (digital scan conversion, preprocessing, and postprocessing) as well as to the analysis of image data (computer-assisted border detection, 3D reconstruction, tissue characterization, and contrast echocardiography); a general introduction to off-line analysis systems was also given. Experience with other cardiac imaging methods indicates that digital techniques will likely play a dominant role in the future of echocardiographic imaging.
Collapse
|
23
|
Mindich BP, Goldman ME, Fuster V, Burgess N, Litwak R. Improved intraoperative evaluation of mitral valve operations utilizing two-dimensional contrast echocardiography. J Thorac Cardiovasc Surg 1985. [DOI: 10.1016/s0022-5223(19)38670-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
24
|
Eguaras MG, Pasalodos J, Gonzalez V, Montero A, Garcia MA, Moriones I, Granados J, Valles F, Concha M. Intraoperative contrast two-dimensional echocardiography. J Thorac Cardiovasc Surg 1985. [DOI: 10.1016/s0022-5223(19)38760-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Reid CL, Chandraratna PA, Rahimtoola SH. Infective endocarditis: improved diagnosis and treatment. Curr Probl Cardiol 1985; 10:1-50. [PMID: 3979094 DOI: 10.1016/s0146-2806(85)80001-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
|
26
|
Goldman ME, Mindich BP, Teichholz LE, Burgess N, Staville K, Fuster V. Intraoperative contrast echocardiography to evaluate mitral valve operations. J Am Coll Cardiol 1984; 4:1035-40. [PMID: 6491070 DOI: 10.1016/s0735-1097(84)80068-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Intraoperative two-dimensional contrast echocardiography was performed on 29 patients undergoing open heart surgery to determine the presence of mitral regurgitation before and immediately after the operative procedure: 14 patients had predominant mitral stenosis, 9 had severe mitral regurgitation and 6 had no mitral valve disease (control subjects). Two-dimensional echocardiography was performed by applying a 5 MHz transducer directly on the heart during injection of saline solution through an apical ventricular sump or transseptal needle, generating contrast microbubbles, with imaging in two planes. Baseline studies were performed after thoracotomy and pericardiotomy before cardiopulmonary bypass, and a second study was done after the operative procedure, with the patient off cardiopulmonary bypass with hemodynamic stabilization before chest closure. No control subject had contrast evidence of mitral regurgitation before or after cardiopulmonary bypass. Two of three patients with mitral valvuloplasty and two of five with commissurotomy required a second operative procedure before chest closure because of persistent mitral regurgitation detected by intraoperative two-dimensional contrast echocardiography. Thirteen of the 15 patients with valve replacement had no mitral regurgitation after cardiopulmonary bypass. Intraoperative two-dimensional echocardiographic findings correlated with data from postoperative clinical examinations and two-dimensional echocardiography-Doppler studies. It is concluded that two-dimensional echocardiography with contrast is an important intraoperative tool for assessing the presence and relative severity of mitral regurgitation after mitral commissurotomy, valvuloplasty or valve replacement. This technique may allow surgeons to be more aggressive in combining reparative operative procedures (that is, commissurotomy and valvuloplasty) in an attempt to retain native valves.
Collapse
|