Contrast Echocardiography

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Agitated saline contrast echocardiography

  • Evaluation for right-to-left intracardiac shunt (enlarged right heart, ASD/PFO)
  • Diagnosis of persistent left-sided SVC
  • Evaluate for PFO as a potential source of cerebral embolic phenomena (stroke, TIA)

Transpulmonary contrast echocardiography

  • Poor left heart endocardial border visualization
  • Diagnosis of left ventricular apical thrombus

Both saline and transpulmonary contrast echocardiography:

  • Known large intracardiac shunt
  • Pregnancy

For transpulmonary contrast echocardiography:

  • Hypersensitivity to perflutren
  • Severe pulmonary hypertension (relative contraindication)
  • Ultrasound system
  • IV access
  • Bacteriostatic 0.9% sodium chloride injection solution
  • Stopcock (three-way)
  • Two 10-mL syringes
  • For transpulmonary contrast echo: contrast agent—usually perfluorocarbons, single vial)

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  1. Discontinue IV.
  • If there is an intra-atrial shunt through a PFO or ASD, saline microbubbles appear in the left atrium immediately after the right atrium fills with contrast. If the patient has an intrapulmonary shunt, microbubbles appear in the left atrium after a delay of several (6 to 8) cardiac cycles from when they are first seen in the right atrium.
  • In cases of persistent left SVC, the injected saline results in opacification of the enlarged coronary sinus in the left atrioventricular groove before opacification of the right side of the heart.
  • Transpulmonary contrast imaging allows for opacification of the LV for improved visualization of endocardial motion or detection of LV thrombus.
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