Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography

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Guidelines for the Cardiac Sonographer in the Performance of Contrast Echocardiography: A Focused Update from the American Society of Echocardiography Thomas R. Porter, MD, FASE, Sahar Abdelmoneim, MD, J. Todd Belcik, BS, RCS, RDCS, FASE, Marti L. McCulloch, MBA, RDCS, FASE, Sharon L. Mulvagh, MD, FASE, Joan J. Olson, BS, RDCS, RVT, FASE, Charlene Porcelli, BS, RDCS, RDMS, FASE, Jeane M. Tsutsui, MD, Kevin Wei, MD, FASE Journal of the American Society of Echocardiography Volume 27, Issue 8, Pages 797-810 (August 2014) DOI: 10.1016/j.echo.2014.05.011 Copyright © 2014 American Society of Echocardiography Terms and Conditions

Figure 1 Demonstration of the different tissue cancelation techniques used with very low MI imaging to enhance microbubble contrast and eliminate tissue signals. Journal of the American Society of Echocardiography 2014 27, 797-810DOI: (10.1016/j.echo.2014.05.011) Copyright © 2014 American Society of Echocardiography Terms and Conditions

Figure 2 Noncontrast (left) and real-time very low MI contrast-enhanced (right) images of a patient with an apical mass in whom real-time very low MI imaging delineates both perfusion and nonperfusion due to endomyocardial fibrosis with thrombus formation (arrow). Journal of the American Society of Echocardiography 2014 27, 797-810DOI: (10.1016/j.echo.2014.05.011) Copyright © 2014 American Society of Echocardiography Terms and Conditions

Figure 3 Contrast-enhanced LV cavity to assist in delineating the extensive apical wall motion abnormality (arrows) associated with takotsubo syndrome. End-diastolic image is on the left and end-systolic image on the right. This is a reverse four-chamber view, and hence the left ventricle is on the left side of the image. Journal of the American Society of Echocardiography 2014 27, 797-810DOI: (10.1016/j.echo.2014.05.011) Copyright © 2014 American Society of Echocardiography Terms and Conditions

Figure 4 Short- and long-term outcomes after both IV Optison and Definity injections in patients with varying severity of PHT. Note no difference in survival compared with a control group with equivalent pressures who did not receive UCAs. Reproduced with permission from Abdelmoneim et al.26 Journal of the American Society of Echocardiography 2014 27, 797-810DOI: (10.1016/j.echo.2014.05.011) Copyright © 2014 American Society of Echocardiography Terms and Conditions

Figure 5 A transesophageal echocardiogram before (left) and after (right) an IV bolus injection of a transpulmonary contrast agent to confirm that the questionable mass in the left atrial appendage (LAA) was just spontaneous contrast. The IV microbubbles completely fill the LAA (right). (See Video 10; available at www.onlinejase.com). Journal of the American Society of Echocardiography 2014 27, 797-810DOI: (10.1016/j.echo.2014.05.011) Copyright © 2014 American Society of Echocardiography Terms and Conditions