Contrast two-dimensional echocardiography in congenital heart disease: Techniques, indications and clinical utility

Abstract

Saline contrast echocardiography was performed in 889 children from June 1976 through February 1988. One-third of these studies were in postoperative patients. A patent foramen ovale was identified by finding right to left shunting on venous contrast injection in 37% of 127 children studied with a structurally normal heart. The incidence of such shunting was greater at younger ages (55% younger than 1 month versus 22% older than 1 month). In most patients with an atrial or ventricular septal defect, some right to left shunting was demonstrable. The technique was useful in distinguishing different forms of atrial septal defect and identifying muscular ventricular septal defects that were difficult to image directly. The technique was used in the catheterization laboratory to aid in the identification of congenital coronary artery fistulas and was diagnostic in two cases of pulmonary arteriovenous malformation. In patients with situs abnormalities, the technique was useful in identifying the systemic venous connections to the atria. Contrast echocardiography was also used in postoperative evaluations. The technique was useful in identifying patch leaks and residual defects after Senning, Mustard and Fontan operations, and after closure of atrial and ventricular septal defects. Most patients were found to have no superior vena cava obstruction by contrast echocardiography after the Senning or Mustard procedure. Contrast echocardiography continues to be a useful technique in the diagnosis of a wide spectrum of congenital heart disease, as well as in the postoperative evaluation of congenital heart surgery.

Congenital Heart Disease in the Older Adult

“…Saline contrast echocardiography was adopted early in CHD echocardiography 311,312 and remains a useful tool in ACHD. Well-agitated saline, including a few drops of the patient's blood, provides dense opacification of the right side of the heart without introduction of "air."…”

Diagnosis and therapeutics of pulmonary arteriovenous fistula in childhood. Case report and review of the literature

“…Two other alternatives in the diagnostic investigation, which were not used in the present case, are the calculation of the shunt through the saturations measured with catheterization in the different cardiac chambers 7 and contrast echocardiography 8,9 , in which agitated saline solution, for example, can be injected in a peripheral vein. The microbubbles resulting from this process and detected in the left atrium determine a right-to-left shunt through the lungs.…”

Contribuição para o diagnóstico e o tratamento das fístulas arteriovenosas pulmonares após a operação de Glenn bidirecional

“…The contrast material consisted of 5.0 mL of saline solution with 0.5 mL of environmental air vigorously mixed by use of a system with 2 taps and 3 connections, producing an opaque saline solution rapidly injected into the patient's vein 11 . The confirmation of the diagnosis of pulmonary arteriovenous fistulae was obtained by detecting the echocardiographic contrast material (bubbles) in the pulmonary veins after a maximum of 8 cardiac cycles.…”