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Contrast echocardiography: Clinical applications

Hanna Ahmed, MD
Section Editor
Warren J Manning, MD
Deputy Editor
Brian C Downey, MD, FACC


Contrast echocardiography is a technique for improving echocardiographic endocardial border delineation and providing real time assessment of intracardiac blood flow. Agitated saline contrast provides contrast in the right heart and enables detection of right-to-left shunts. Opacification of the left ventricular (LV) cavity by contrast agents developed to traverse the pulmonary vasculature permits improved left ventricular endocardial border detection, thus improving the assessment of left ventricular dimensions and wall motion. Contrast echocardiography can also enhance delineation of Doppler signal. Additional uses of contrast echocardiography include assessment of myocardial perfusion.

The current and potential clinical applications of this technique will be reviewed here. The development and safety of microbubbles for echocardiographic contrast and the optimization of the echocardiographic settings for visualizing contrast are discussed separately. (See "Contrast echocardiography: Contrast agents, safety, and imaging technique".)


Shunt detection — The first clinical use of contrast echocardiography was for detection of right-to-left shunts [1]. Agitated saline is well-suited for this purpose because microbubbles of air formed from agitating saline persist long enough to opacify the right heart chambers and diffuse into the lungs when traveling through the pulmonary circulation. Therefore, microbubbles will not gain access to the left heart chambers unless a right-to-left intracardiac or extracardiac shunt is present.

This technique is used most often for the detection of atrial septal defects, although it can also be used to detect ventricular septal defects and arteriovenous shunts in the pulmonary vasculature. The appearance of bubbles in the left heart early (within three to five beats) after right chamber opacification suggests an intracardiac shunt [2]. Later appearance of bubbles in the left heart suggests pulmonary arteriovenous shunting. (See "Identification and assessment of atrial septal defects in adults" and "Pulmonary arteriovenous malformations: Clinical features and diagnostic evaluation in adults".)

Microbubble contrast agents such as Optison, Definity, and Lumason that traverse the pulmonary vasculature are NOT designed for shunt detection.

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Literature review current through: Dec 2017. | This topic last updated: Sep 20, 2017.
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