title: The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure.
abstract: OBJECTIVE
  We assessed an air-blood-saline mixture for Doppler measurement of pulmonary artery systolic pressure (PASP) and the mechanism of enhancement of the Doppler signal by this mixture.
  
  
  BACKGROUND
  Underestimation of PASP by Doppler echocardiography occurs with inadequate continuous wave (CW) signals of tricuspid regurgitation (TR).
  
  
  METHODS
  We assessed in vitro the diameter and concentration of microbubbles of agitated air-saline mixture, air-blood-saline mixture and 10% air-10% plasma-80% saline mixture immediately, 5, 10 and 20 s after agitation. In 20 patients, PASP was estimated by Swan-Ganz catheter and CW Doppler of TR: 1) without contrast injection; 2) with intravenous injection of 10% air-90% saline; and 3) 10% blood-10% air-80% saline mixture.
  
  
  RESULTS
  Compared to air-saline, addition of blood or plasma to the air-saline solution significantly increased the concentration of microbubbles (p < 0.001). The air-blood-saline (26.7 +/- 7.2 microm) and air-plasma-saline mixture (25.3 +/- 7.4 microm) had smaller microbubbles than air-saline mixture (31.6 +/- 8.2 microm) (p < 0.001). The correlation between Doppler- and catheter-measured PASP at baseline (r = 0.64) improved with agitated air-saline (r = 0.86). With the air-blood-saline mixture, the correlation further improved (r = 0.92) and the best limits of agreement were obtained.
  
  
  CONCLUSIONS
  The combination of the patient's own blood is a method of making a sterile solution of numerous small microbubbles for injection into the right-sided cardiac chambers. Clinically, the air-blood-saline mixture is easily prepared at bedside and is superior to the air-saline mixture in assessing PASP in patients with inadequate CW Doppler signals.
authors.affiliation: Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
authors.forename: Doo-Soo
authors.initials: DS
authors.lastname: Jeon
authors.forename: Huai
authors.initials: H
authors.lastname: Luo
authors.forename: Takahiro
authors.initials: T
authors.lastname: Iwami
authors.forename: Takashi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Andrea V
authors.initials: AV
authors.lastname: Brasch
authors.forename: James
authors.initials: J
authors.lastname: Mirocha
authors.forename: Tasneem Z
authors.initials: TZ
authors.lastname: Naqvi
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D001794:Blood Pressure; D003287:Contrast Media; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006801:Humans; D007089:Image Enhancement / Q000379:methods*; D008297:Male; D008863:Microspheres; D011651:Pulmonary Artery / Q000502:physiology*; D014262:Tricuspid Valve Insufficiency / Q000000981:diagnostic imaging*
chemical_list: D003287:Contrast Media