[Intrapulmonary arterial injection of Albunex for left heart contrast echocardiography]

Contrast enhancement of the left heart cavity and myocardium were assessed after venous injection of the ultrasound contrast agent Albunex. Myocardial perfusion was also assessed using a drug stress and image analyzing system. The study population consisted of 46 patients with normal cardiac function and without coronary artery disease, and 38 patients with effort angina. Contrast echocardiography was performed by imaging the parasternal or apical long-axis view during pulmonary arterial injection of Albunex through a Swan-Ganz catheter. Contrast enhancement in the left ventricular cavity and ascending aorta were visually assessed. Hemodynamic, arterial blood gas and electrocardiography changes were recorded before and after the injection of Albunex. Contrast echocardiography was performed before and during intravenous infusion of dipyridamole to assess left ventricular myocardial enhancement by both visual inspection and peak background-subtracted gray level using an image analyzing system. Doppler flow signal change after the injection of Albunex was assessed in 26 patients using a Doppler guide wire located in the left anterior descending coronary artery. Good contrast enhancement was obtained in all patients in the left ventricular cavity and in 17% of patients in the ascending aorta. No significant changes were observed in hemodynamics, electrocardiograms and aortic gas analysis. Significant myocardial enhancement was not seen in any patient but gray level analysis of the echo images during dipyridamole infusion showed significant enhancement in 25% of the patients without coronary artery disease and in 34% of the patients with effort angina. Doppler flow signal in the coronary artery was significantly augmented in all patients after injection of Albunex and suggests that ultrasound contrast agent reaches coronary arteries in all patients regardless of myocardial contrast enhancement. Contrast echocardiography with pulmonary arterial injection of Albunex is safe and useful to obtain sufficient left ventricular contrast enhancement. For myocardial perfusion assessment, further refinement of the ultrasound contrast agent and echo equipment is necessary.