Is there a role for intravenous transpulmonary contrast imaging in pediatric stress echocardiography?
OBJECTIVE
Intravenous transpulmonary contrast echocardiography plays a significant role in the enhancement of endocardial border delineation during stress echocardiography in the adult population. The current study was conducted to evaluate the feasibility of intravenous transpulmonary contrast in pediatric patients and to compare the quality of endocardial visualization by harmonic 2-dimensional (2D) imaging alone with harmonic 2D echocardiography with contrast imaging.


METHODS
Twenty-two children, age 9.3 +/- 3.9 underwent dobutamine (19 patients) or exercise (3 patients) stress echocardiography. None had intracardiac shunting. Each patient underwent both harmonic 2D imaging alone and harmonic 2D imaging with contrast administration at peak stress. Oxygen saturation, heart rate, and blood pressure were monitored. Endocardial delineation was evaluated by qualitative grading of 22 endomyocardial regional segments in each patient. Contrast images were graded by an echocardiographer who was blinded to the scores previously assigned to harmonic 2D echocardiography images.


RESULTS
There were no changes in saturation, heart rate, or blood pressure during or after contrast administration. Use of contrast significantly improved endocardial visualization in 11 of 22 segments (P <.05), particularly lateral, apical, and anterior left ventricular wall segments.


CONCLUSIONS
Intravenous intrapulmonary administration is feasible and has no obvious adverse effects in a small pediatric patient group. Contrast echocardiography improves endocardial border delineation over harmonic imaging in pediatric stress echocardiography.
Zilberman
Mark V
MV
Noninvasive Cardiac Imaging and Hemodynamic Research Laboratory, Division of Cardiology, Cincinnati Children's Hospital Medical Center.
Witt
Sandra A
SA
Kimball
Thomas R
TR
D000293:Adolescent; D000328:Adult; D001794:Blood Pressure / Q000187:drug effects; D015992:Body Mass Index; D002648:Child; D002669:Child Welfare; D002675:Child, Preschool; D003287:Contrast Media / Q000008:administration & dosage*; D003326:Coronary Circulation / Q000187:drug effects / Q000502:physiology; D025401:Echocardiography, Stress; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology; D006339:Heart Rate / Q000187:drug effects; D006801:Humans; D007089:Image Enhancement; D007223:Infant; D007229:Infant Welfare; D007262:Infusions, Intravenous; D010100:Oxygen / Q000097:blood
D003287:Contrast Media; D010100:Oxygen