Established and emerging roles for ultrasound enhancing agents (contrast echocardiography)

Figures

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  Figure 1. Left Panel: the unenhanced 4‐chamber echo in a patient with a technically suboptimal image. Right Panel: delineation of the endocardial border after left ventricular opacification with contrast.

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  Figure 2. Left Panel: the aortic stenosis jet recorded from a patient with poor ultrasound transmission. Right Panel: the aortic stenosis jet after contrast injection; a jet velocity of approximately 250 cm/s is seen.

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  Figure 3. Left Panel: tricuspid regurgitant jet velocity with a suboptimal resting echo yielding an estimated right ventricular pressure of 12 mm/Hg. Right Panel: after contrast enhancement a tricuspid regurgitant jet in excess of 3 m/s is recorded yielding a right ventricular pressure of 38 mm of mercury.

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  Figure 4. The upper panels show the 4‐chamber (left) 2‐chambers (center) and 3‐chamber (right) unenhanced echo images in a patient with hypertrophic cardiomyopathy. Bottom panels demonstrate a clear delineation of the apical hypertrophy in all three individual views after contrast injection.

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  Figure 5. A patient with apical hypertrophic cardiomyopathy which is not well delineated in the unenhanced apical 4‐chamber view (left), well delineated following contrast (center), and demonstrates an apical aneurysm in mid systole (right)

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  Figure 6. Left Panel: the apical 4 chamber recording before contrast injection while the right panel clearly demonstrates an apical thrombus following administration of an ultrasound enhancing agent

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  Figure 7. Left panel delineates an apical thrombus that is free of any ultrasound reflectances. Middle panel show the echo of a patient with a large apical tumor that contains reflectances generated by tissue in homogeneity. Right panel demonstrates the same tumor after contrast agent administration which clearly delineates the persistent vasculature.

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  Figure 8. Left Panel demonstrates a marked hypertrabecular pattern in a patient with noncompaction while the right panel illustrates that contrast fills the intrabecular clefts delineating the compacted myocardium

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  Figure 9. Left panels show the unenhanced four chamber view in a patient with a dilated cardiomyopathy before contrast enhancement while the right panel administration of enhancing agents shows the thin compacted myocardium and that the apparent endocardial border of the ventricle consists of hypertrabeculation

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  Figure 10. Images from a preclinical study in the parasternal short axis view before (left) and following (right) the intracoronary injection CO2

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  Figure 11. The myocardial contrast echocardiogram obtained in a normal subject. Left panel is taken at the arrival of left ventricular contrast while the right panel shows myocardial opacification delineating myocardial perfusion.

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  Figure 12. Left panel demonstrates myocardial contrast echocardiogram in a patient with an anterior myocardial infarction in whom virtually no apical opacification is seen indicative of nonviable myocardium. The panel on the right shows another patient with an anterior apical myocardial infarction in whom at least partial apical opacification exists suggesting myocardial viability.