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The usefulness of a 10% air-10% blood-80% saline mixture for contrast echocardiography: Doppler measurement of pulmonary artery systolic pressure

^* Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, California, USA

View larger version (65K): [in a new window]   Figure 1 Microscopic features (100x magnification) of (A) agitated 10% air-90% saline mixture, (B) 10% air-10% blood-80% saline mixture and (C) 10% air-10% plasma-80% saline mixture immediately after agitation. Compared with the air-saline mixture (A), the addition of blood (B) or plasma (C) to the air-saline mixture significantly increased the number of microbubbles.

View larger version (15K): [in a new window]   Figure 2 Log of the mean number of microbubbles versus time after agitation. The estimated half-lives of the microbubbles are 4.22 s for agitated 10% air-90% saline mixture, 4.96 s for agitated 10% air-10% blood-80% saline mixture and 4.64 s for agitated 10% air-10% plasma-80% saline mixture.

View larger version (41K): [in a new window]   Figure 3 Effect of contrast enhancement of continuous wave (CW) signal of tricuspid regurgitation (TR). (A) Before contrast enhancement, TR signal was not detected. (B) With the injection of 10% air-90% saline mixture or (C) 10% air-10% blood-80% saline mixture, complete CW signal of TR could be observed. But the air-blood-saline mixture exhibited a higher peak velocity compared with the air-saline mixture.

View larger version (12K): [in a new window]   Figure 4 Correlation of catheter-measured pulmonary artery systolic pressure (PASP) and PASP measured by continuous wave Doppler without a contrast agent (A), after injection of agitated 10% air-90% saline (B) and after injection of the agitated 10% air-10% blood-80% saline mixture (C).

View larger version (12K): [in a new window]   Figure 5 Agreement between Doppler estimations and catheter measurements of pulmonary artery systolic pressure (PASP). Mean difference between the methods ( PASP Catheter-Doppler) is plotted against their average PASP. A = no contrast agent; B = 10% air-90% saline mixture; C = 10% air-10% blood-80% saline mixture.