Clinical application of transpulmonary contrast-enhanced Doppler technique in the assessment of severity of aortic stenosis

Nakatani, Satoshi; Imanishi, Toshio; Terasawa, Akihiro; Beppu, Shintaro; Nagata, Seiki; Miyatake, Kunio

doi:10.1016/0735-1097(92)90200-7

Cited by 52 publications

(25 citation statements)

References 22 publications

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“…Underestimation is a valid concern when confronted with decision for surgery. Contrast has been shown to result in an improvement in the determination of the peak Doppler velocity AS profile, allowing a more accurate trans-aortic gradient estimation (Nakatani S et al, 1992). Importantly, in this study, the authors noted that patients with weak Doppler signals demonstrated improvements in their image profiles, but even those with adequate unenhanced Doppler signals were further improved by the use of contrast.…”

Section: Left Heartmentioning

confidence: 50%

Doppler Contrast Echocardiography

Sorrell¹,

Kumar²

2011

Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology

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Section: Left Heartmentioning

confidence: 50%

Doppler Contrast Echocardiography

Sorrell¹,

Kumar²

2011

Establishing Better Standards of Care in Doppler Echocardiography, Computed Tomography and Nuclear Cardiology

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“…Intravenous sonicated albumin has also been utilized to improve left-sided Doppler signals across the aortic valve [19]. Since the albumin microbubbles are smaller, the major limitation with this application has been the short duration of signal enhancement in the patients with aortic stenosis due to pressure instability of albumin microbubbles.…”

Section: Clinical Implications Of a Larger Microbubblementioning

confidence: 98%

The mechanism and clinical implication of improved left ventricular videointensity following intravenous injection of multi-fold dilutions of albumin with dextrose

1995

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The left ventricular ultrasound videointensity of an intravenous injection of sonicated albumin is improved if the agent is diluted with dextrose prior to sonication. The objective of this study was to determine the mechanism for improved left ventricular ultrasound contrast with intravenous sonicated multi-fold dilutions of albumin with dextrose compared to sonicated albumin alone. Epicardial short axis images of the left ventricle were obtained in 11 mongrel dogs and incremental one part sonicated dilutions (up to 10-fold) of albumin with 5 or 50% dextrose were given intravenously to determine which dilution and dextrose concentration produced optimal left ventricular videointensity. Microbubble size and concentration of these dilutions were measured. The one to seven-fold sonicated dilutions resulted in a slight, but significantly larger microbubble size when compared to sonicated albumin alone (SA), but no difference in concentration. All dilutions produced significantly higher end-diastolic peak videointensity (PVI) in the left ventricle than SA (range 160-569% of SA PVI; p < 0.001) with the three to five-fold dilution producing maximal PVI. Five percent dextrose dilutions produced the same videointensity as 50% dilutions. End-systolic videointensity of both 5 and 50% dextrose dilutions were also over 250% higher than SA (p < 0.001). This resulted in good or excellent end-systolic endocardial border definition in the majority of injections. Therefore, the mechanism for improved left ventricular chamber opacification with multifold sonicated dilutions of albumin with dextrose appears to be due to a small increase in microbubble size and not increased viscosity or microbubble concentration.

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“…Some patients with aortic stenosis may have suboptimal acoustic window or Doppler recordings, and contrast echocardiography may be of help in these cases [18,19]. In one study by Nakatani et al [20], the transaortic Doppler recording was of sufficient quality after intravenous injection of sonicated albumin in patients in which the aortic velocity envelope was too indistinct to determine the peak velocity before contrast administration. In that study, aortic valve area measured after contrast administration had a strong correlation with that obtained invasively by Gorlin's formula [20].…”

Section: Contrast Echocardiographymentioning

confidence: 99%