title: Ultrasound contrast and real-time perfusion in conjunction with supine bicycle stress echocardiography for comprehensive evaluation of surgically corrected congenital heart disease.
abstract: OBJECTIVE
  We sought to evaluate the efficacy of ultrasound contrast (UC) and low mechanical index real-time perfusion (RTP) in the haemodynamic and anatomic assessment of repaired congenital heart disease (CHD) at rest and during supine bicycle stress echocardiography (BSE).
  
  
  RESULTS
  Patients with CHD (n = 51, median age 21.5 years) were prospectively studied. All had compromised image quality, 20 (39%) had arrhythmias, and 10 (20%) had pacemakers. RTP was performed at rest and during BSE using Definity and Contrast Pulse Sequencing, with assessment of Doppler pressure gradients. Diagnoses included tetralogy of Fallot (n = 27), transposition of the great arteries (TGA) atrial switch (n = 10), TGA arterial switch (n = 2), aortic valve disease (n = 4), Fontan (n = 4), and Kawasaki disease (n = 4). UC with RTP improved endocardial border definition, with increased number of left ventricular (LV) and right ventricular (RV) segments visualized at rest (P < 0.0001) and during stress. LV ejection fraction (EF) and RV fractional area change (FAC) were measurable at rest and peak stress, RV FAC correlating closely with same-day magnetic resonance EFs (r = 0.72; P < 0.001). UC enhanced Doppler signals, enabling subpulmonary ventricular systolic pressure measurements at rest and stress. In six patients, marked elevations of subpulmonary ventricular systolic pressure were detected with UC during BSE, and quantifiable ventricular dysfunction. No adverse events occurred, other than transient low back pain in one patient.
  
  
  CONCLUSIONS
  UC at rest and with supine BSE enables safe and comprehensive assessment of anatomy, haemodynamics, and biventricular functional and perfusion reserve in adolescents and young adults with surgically modified CHD.
authors.affiliation: Joint Division of Pediatric Cardiology, University of Nebraska College of Medicine/Creighton University, Children's Hospital and Medical Center, Omaha, NE, USA.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.forename: Joan
authors.initials: J
authors.lastname: Olson
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Danford
authors.forename: Erin K
authors.initials: EK
authors.lastname: Sandene
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.forename: Scott E
authors.initials: SE
authors.lastname: Fletcher
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Erickson
authors.forename: John D
authors.initials: JD
authors.lastname: Kugler
authors.forename: David A
authors.initials: DA
authors.lastname: Danford
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D000328:Adult; D003287:Contrast Media; D025401:Echocardiography, Stress / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D005466:Fluorocarbons; D019786:Gadolinium DTPA; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D006439:Hemodynamics; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D016014:Linear Models; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D009329:Nebraska; D011446:Prospective Studies; D018709:Statistics, Nonparametric; D016683:Supine Position
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; D019786:Gadolinium DTPA; C042852:perflutren