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Figure 1 These myocardial contrast echocardiography (MCE) images were obtained in a 52-year-old man, two days after he presented with an anterior myocardial infarction. (a) Apical long-axis perfusion image revealing a normally perfused posterior wall (white arrow) and an anteroseptal and apical transmural perfusion defect (yellow arrow). In these power pulse inversion MCE images, the left ventricular (LV) cavity appears yellow, whereas the perfused myocardium appears orange. (b) "Flash" imaging with a high mechanical index (see text for details). (c) The image immediately after "flash" or destruction frames. Note a lack of contrast effect throughout the myocardium, with residual LV cavity opacification. (d) Several cardiac cycles later after microbubble replenishment, perfusion is again noted in the posterior wall, with a perfusion defect in the left anterior descending coronary artery distribution. As predicted by MCE, follow-up echocardiography nearly two months later revealed continued akinesia throughout the infarct zone.