McMahon C J, Ayres N A, Bezold L I, Lewin M B, Alonzo M, Altman C A, Kovalchin J P, Eidem B W, Pignatelli R H
Noninvasive Imaging Cardiac Laboratory, Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin MC 19345-C, Houston, TX 77030, USA.
Pediatr Cardiol. 2005 Jul-Aug;26(4):413-7. doi: 10.1007/s00246-004-0795-1.
This study was performed to determine the safety and efficacy of intravenous contrast echocardiography in children attending a tertiary cardiac center. This was a prospective study to evaluate the use of Optison contrast agent in children with severely limited transthoracic echocardiographic windows. Twenty children (median age, 15 years; range, 9-18) underwent fundamental imaging (FI), harmonic imaging (HI), and HI with intravenous contrast (Optison FS-069). Endocardial border delineation was determined based on a visual qualitative scoring system (0, none: 4, excellent). Endocardial border definition was significantly improved in all patients using contrast echocardiography (FI vs Optison, p < 0.001 for each). Improved border definition was most dramatic in the apical and left ventricular (LV) free wall regions. Left ventricular ejection fraction (LVEF) was measurable in 20 patients (100%) using contrast compared to 11 (55%) with FI or HI (p < 0.05). The echocardiographic diagnosis was correctly delineated in 1 patient with a severely dyskinetic LV segment only with use of intravenous contrast and HI. No patients suffered adverse hemodynamic effects, changes in taste, or flushing episodes. Three patients experienced transient headaches. Intravenous contrast echocardiography offers an additional tool in evaluating children with very poor transthoracic echocardiographic windows. Such a strategy increases diagnostic accuracy and allows accurate LVEF determination. Adverse hemodynamic effects related to intravenous contrast are exceedingly rare.
本研究旨在确定在一家三级心脏中心就诊的儿童中静脉注射造影剂超声心动图的安全性和有效性。这是一项前瞻性研究，旨在评估Optison造影剂在经胸超声心动图窗严重受限的儿童中的应用。20名儿童（年龄中位数为15岁；范围为9 - 18岁）接受了基础成像（FI）、谐波成像（HI）以及静脉注射造影剂（Optison FS - 069）后的HI检查。根据视觉定性评分系统（0分，无；4分，极佳）确定心内膜边界的描绘情况。在所有患者中，使用造影剂超声心动图后心内膜边界的定义均有显著改善（FI与Optison相比，每次p < 0.001）。边界定义的改善在心尖和左心室（LV）游离壁区域最为显著。使用造影剂时，20名患者（100%）可测量左心室射血分数（LVEF），而使用FI或HI时为11名患者（55%）（p < 0.05）。仅在使用静脉注射造影剂和HI时，1名左心室节段严重运动障碍的患者的超声心动图诊断才得以正确描绘。没有患者出现不良血流动力学效应、味觉改变或潮红发作。3名患者经历了短暂性头痛。静脉注射造影剂超声心动图为评估经胸超声心动图窗非常差的儿童提供了一种额外的工具。这种策略提高了诊断准确性，并能准确测定LVEF。与静脉注射造影剂相关的不良血流动力学效应极为罕见。
