Agitated colloid is superior to saline and equivalent to Levovist in enhancing tricuspid regurgitation Doppler envelope and in the opacification of right heart chambers: A quantitative, qualitative, and cost-effectiveness study

Tan, Hiok C; Fung, Kevin C.; Kritharides, Leonard

doi:10.1067/mje.2002.116717

Cited by 18 publications

(13 citation statements)

References 22 publications

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“…2002). Th e agitated gelatin bubbles have a similar but more consistent size and superior enhancement of Doppler signals when compared to agitated saline bubbles (Tan et al . 2002).…”

Section: Methodsmentioning

confidence: 99%

“…Manually agitated gelatin bubbles create an opacification of the right ventricle but do not usually traverse the pulmonary circulation at rest (Kaul, 1997;Cabanes et al 2002). The agitated gelatin bubbles have a similar but more consistent size and superior enhancement of Doppler signals when compared to agitated saline bubbles (Tan et al 2002). A positive PTAC was defined as the appearance of contrast bubbles in the left atrium more than four cardiac cycles following opacification of the right ventricle (Stickland et al 2004).…”

Section: Pulmonary Transit Of Agitated Contrastmentioning

confidence: 99%

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Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals

Lalande

Yerly

Faoro

et al. 2012

The Journal of Physiology

105

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Key points• Pulmonary transit of agitated contrast (PTAC) occurs during exercise in healthy individuals.• It has been suggested that positive PTAC reflects a greater pulmonary vascular reserve, allowing for the right ventricle to operate at a decreased afterload at high levels of exercise.• In this study, we determined whether individuals with highest maximal aerobic capacity have the greatest pulmonary vascular distensibility, highest PTAC and greatest increase in the capillary blood component of lung diffusing capacity during exercise.• We observed that individuals with highest maximal aerobic capacity have a more distensible pulmonary circulation as observed through greater pulmonary vascular distensibility, greater pulmonary capillary blood volume, and lowest pulmonary vascular resistance at maximal exercise.• Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals.Abstract It has been suggested that shallow slopes of mean pulmonary artery pressure (MPPA)-cardiac output (Q ) relationships and pulmonary transit of agitated contrast during exercise may be associated with a higher maximal aerobic capacity (V O 2 max ). If so, individuals with a higherV O 2 max could also exhibit a higher pulmonary vascular distensibility and increased pulmonary capillary blood volume during exercise. Exercise stress echocardiography was performed with repetitive injections of agitated contrast and measurements of MPPA,Q and lung diffusing capacities for carbon monoxide (D L,CO ) and nitric oxide (D L,NO ) in 24 healthy individuals. A pulmonary vascular distensibility coefficient α was mathematically determined from the slight natural curvilinearity of multipoint MPPA-Q plots. Membrane (D m ) and capillary blood volume (V c ) components of lung diffusing capacity were calculated. Maximal exercise increased MPPA, cardiac index (CI), D L,CO and D L,NO . The slope of the linear best fit of MPPA-CI was 3.2 ± 0.5 mmHg min l −1 m 2 and α was 1.1 ± 0.3% mmHg −1 . A multivariable analysis showed that higher α and greater V c independently predictedV O 2 max . All individuals had markedly positive pulmonary transit of agitated contrast at maximal exercise, with increases proportional to increases in pulmonary capillary pressure and V c . Pulmonary transit of agitated contrast was not related to pulse oximetry arterial oxygen saturation. Therefore, a more distensible pulmonary circulation and a greater pulmonary capillary blood volume are associated with a higherV O 2 max in healthy individuals. Agitated contrast commonly transits through the pulmonary circulation at exercise, in proportion to increased pulmonary capillary pressures.

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“…2002). Th e agitated gelatin bubbles have a similar but more consistent size and superior enhancement of Doppler signals when compared to agitated saline bubbles (Tan et al . 2002).…”

Section: Methodsmentioning

confidence: 99%

Section: Pulmonary Transit Of Agitated Contrastmentioning

confidence: 99%

Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals

Lalande

Yerly

Faoro

et al. 2012

The Journal of Physiology

105

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“…40,41 Direct comparisons between the effectiveness of saline-air or gelatin-air mixtures in detecting Q IPAVA is limited, however work by Tan et al has shown gelatin-air contrast to persist longer than saline-air contrast. 42 Attempts to quantify bubble diameter using saline-air contrast have reported a size distribution of 24-144 lm, with the majority being~30-70 lm in diameter. 43 Similarly the bubble diameter of gelatin-air contrast has been reported to be a mean of 21 AE 6 lm.…”

Section: Saline Contrast Echocardiographymentioning

confidence: 99%

Clinical Consideration for Techniques to Detect and Quantify Blood Flow through Intrapulmonary Arteriovenous Anastomoses: Lessons from Physiological Studies

2015

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Intrapulmonary arteriovenous anastomoses (IPAVA) are large diameter (>50 μm) vascular conduits, present in >95% of healthy humans. Because IPAVA are large diameter pathways that allow blood flow to bypass the pulmonary capillary network, blood flow through IPAVA (QIPAVA) can permit the transpulmonary passage of particles larger than pulmonary capillaries. IPAVA have been known to exist for over 50 years, but their physiological and clinical significance are still being established; although, currently suggested roles for QIPAVA include allowing emboli to reach the systemic circulation and providing a source of shunt. Studying QIPAVA is an important area of research and as the suggested roles become better established, detecting and quantifying QIPAVA may become significantly more important in the clinic. Several techniques that can be used to quantify and/or detect QIPAVA in animals, ex vivo human/animal lungs, and intact healthy humans; microspheres, radiolabeled macroaggregated albumin particles, and saline contrast echocardiography, are reviewed with limitations and advantages to each. The current body of literature using these techniques to study QIPAVA in animals, ex vivo lungs, and healthy humans has established conditions when QIPAVA is present, such as during exercise or with arterial hypoxemia and conditions when QIPAVA is absent, such as at rest or during exercise breathing 100% O2 . Many of these physiological studies have direct application to patient populations and we discuss each of these findings in the context of their potential to influence the clinical utility, and interpretation, of the results from these techniques highlighted in this review.

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“…The mechanism is not exactly known. The syndrome may be caused by increased hepatic production of vasodilators, such as nitric oxide, which causes a ventilation perfusion mismatch (relative overperfusion) and hypoxemia on exertion 1. Additionally, an increased gradient between the partial pressure of oxygen in the pulmonary alveoli and adjacent arteries (alveolar-arterial (A-a) gradient) exists 2.…”

Section: Answer: Dmentioning

confidence: 99%

A cardiac diagnosis by contrast echocardiography

Brugts

Michels

Uil

2014

Heart

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Agitated colloid is superior to saline and equivalent to Levovist in enhancing tricuspid regurgitation Doppler envelope and in the opacification of right heart chambers: A quantitative, qualitative, and cost-effectiveness study

Cited by 18 publications

References 22 publications

Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals

Pulmonary vascular distensibility predicts aerobic capacity in healthy individuals

Clinical Consideration for Techniques to Detect and Quantify Blood Flow through Intrapulmonary Arteriovenous Anastomoses: Lessons from Physiological Studies

A cardiac diagnosis by contrast echocardiography

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