title: The Feasibility and Clinical Utility of Microsphere Contrast-enhanced Transthoracic Echocardiography in Adult Congenital Heart Disease.
abstract: BACKGROUND
  Transthoracic echocardiography (TTE) plays a key role in adult congenital heart disease (ACHD). However, a significant number of studies are nondiagnostic due to poor image quality. Enhancement of the blood pool-tissue interface with contrast-enhanced TTE (CE-TTE) can improve image quality in suboptimal studies. The aim of this analysis was to evaluate feasibility and clinical utility of CE-TTE in the assessment of patients with ACHD.
  
  
  METHODS
  A retrospective analysis of all CE-TTE performed in ACHD patients at our institution from August 2007 to May 2014 was performed. Endocardial definition scores (EDS) for each segment in the right and left ventricles were graded pre- and postcontrast imaging, as 1 = good, 2 = suboptimal, 3 = not seen. The endocardial border definition score index (EBDSI) was also calculated pre- and postcontrast imaging.
  
  
  RESULTS
  Twenty patients with ACHD had 24 CE. Summation data for all ventricular EDS for unenhanced TTE vs. CE-TTE imaging was: EDS 1 = 136 vs. 314, EDS 2 = 119 vs. 72, EDS 3 = 162 vs. 31, respectively. Wilcoxon matched-pairs rank-signed test showed a significant ranking difference (improvement) pre- and postcontrast for the combined ventricular data (P < .0001) and the individual left and right ventricular data (all P < .0001). The EBDSI for combined ventricular data using CE-TTE was significantly lower than for noncontrast imaging (1.23 ± 0.49 vs. 2.06 ± 0.62, P < .0001). There was one minor contrast adverse reaction.
  
  
  CONCLUSIONS
  CE-TTE resulted in significantly improved right and left ventricular endocardial definition and improved EDBSI. CE-TTE should be viewed as an additional imaging technique that is available to help assess patients with ACHD, especially those with nondiagnostic images.
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: David G
authors.initials: DG
authors.lastname: Platts
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Natalie F A
authors.initials: NF
authors.lastname: Kelly
authors.affiliation: Adult Congenital Heart Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Vishva A
authors.initials: VA
authors.lastname: Wijesekera
authors.affiliation: Cardiology Department, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Abhishek
authors.initials: A
authors.lastname: Sengupta
authors.affiliation: Adult Congenital Heart Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Kylie
authors.initials: K
authors.lastname: Burns
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Darryl J
authors.initials: DJ
authors.lastname: Burstow
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Thomas
authors.initials: T
authors.lastname: Butler
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Adult Congenital Heart Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.|School of Medicine, The University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Dorothy J
authors.initials: DJ
authors.lastname: Radford
authors.affiliation: Department of Echocardiography, The Prince Charles Hospital, Brisbane, Queensland, Australia.|Adult Congenital Heart Service, The Prince Charles Hospital, Brisbane, Queensland, Australia.
authors.forename: Mugur
authors.initials: M
authors.lastname: Nicolae
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D003287:Contrast Media / Q000008:administration & dosage*; D004452:Echocardiography / Q000379:methods*; D004699:Endocardium / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005240:Feasibility Studies; D005260:Female; D005466:Fluorocarbons / Q000008:administration & dosage*; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D011237:Predictive Value of Tests; D011793:Queensland; D012189:Retrospective Studies; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right; D055815:Young Adult
chemical_list: D003287:Contrast Media; D005466:Fluorocarbons; C042852:perflutren
keywords: Adult Congenital Heart Disease; Contrast Microspheres; Transthoracic Echocardiography