title: Safety and Efficacy of Cardiac Ultrasound Contrast in Children and Adolescents for Resting and Stress Echocardiography.
abstract: Small pilot studies of ultrasound contrast (UC) echocardiography in children have suggested that it is safe; therefore, larger scale evaluation of safety and efficacy in this population is of particular interest.
  
  
  
  This was a retrospective study (January 2005 to June 2014). Known intracardiac shunt was the only exclusion criterion. UC echocardiography was performed on commercially available ultrasound systems using Definity (3% infusion). When indicated, real-time myocardial contrast echocardiography was performed at rest and stress, with examination of myocardial contrast replenishment, plateau intensity, and wall motion. The primary outcome was short-term safety and efficacy (<24 hours).
  
  
  
  In all, 113 patients (55% male; mean age, 17.8 ± 3 years; age range, 5-21 years) underwent UC echocardiography for left ventricular opacification or stress wall motion and perfusion analysis. Diagnosis categories were congenital heart disease (30%), acquired heart disease (21%), and other (suspected cardiac complications of disease of other organ systems; 49%). Twelve patients (11%) with right ventricular systolic pressures > 40 mm Hg received UC without complications; four of these (33%) had the highest right ventricular-right atrial gradient recorded with ultrasound contrast-enhanced Doppler. Myocardial perfusion and/or UC echocardiography-detected wall motion abnormalities were seen in 13 patients (12%); four had confirmed correlations by angiography or magnetic resonance imaging. There were 13 instances of adverse events or reported symptoms during UC echocardiography. All symptoms and events were transient, all patients completed protocols, and there were no immediate sequelae.
  
  
  
  These data demonstrate the usefulness and safety of UC echocardiography in children and adolescents for a wide variety of indications. UC echocardiography provided myocardial perfusion and wall motion information important in clinical decision making.
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska. Electronic address: skutty@unmc.edu.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska.
authors.forename: Yunbin
authors.initials: Y
authors.lastname: Xiao
authors.affiliation: Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Joan
authors.initials: J
authors.lastname: Olson
authors.affiliation: Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Feng
authors.initials: F
authors.lastname: Xie
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska.
authors.forename: David A
authors.initials: DA
authors.lastname: Danford
authors.affiliation: Division of Pediatric Cardiology, University of Nebraska College of Medicine, Children's Hospital & Medical Center, Omaha, Nebraska.
authors.forename: Christopher C
authors.initials: CC
authors.lastname: Erickson
authors.affiliation: Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, Nebraska.
authors.forename: Thomas R
authors.initials: TR
authors.lastname: Porter
mesh_terms: D000293:Adolescent; D001145:Arrhythmias, Cardiac / Q000175:diagnosis / Q000453:epidemiology*; D015984:Causality; D002637:Chest Pain / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015897:Comorbidity; D004244:Dizziness / Q000175:diagnosis / Q000453:epidemiology; D004417:Dyspnea / Q000175:diagnosis / Q000453:epidemiology; D025401:Echocardiography, Stress / Q000379:methods*; D005221:Fatigue / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D008297:Male; D009329:Nebraska / Q000453:epidemiology; D010146:Pain / Q000175:diagnosis / Q000453:epidemiology*; D061214:Patient Safety / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D055815:Young Adult
keywords: Adult congenital heart disease; Echocardiography; Pediatric; Stress echocardiography; Ultrasound contrast