Department of Cardiology, Medical University in Bialystok, Poland.
Kardiol Pol. 2011;69(7):680-6.
Myocardial contrast echocardiography (CE) improves the quality of standard echocardiography. The value of CE during the early post-operative period after coronary artery bypass grafting (CABG) has not yet been well established.
To evaluate the accuracy and safety of CE used for the assessment of left ventricular (LV) function in patients after CABG in the setting of a cardiosurgery post-operative unit (CPU) in comparison with conventional transthoracic echocardiography (TTE).
Echocardiographic contrast agent Sono-Vue (Bracco, Italy) was administered in 30 consecutive patients with technically difficult TTE, after CABG treated in the CPU. Improved quality of echocardiographic imaging was assessed by the number of analysable LV segments. The LV end-diastolic and end-systolic volume (LVEDV, LVESV) and LV ejection fraction (LVEF) were calculated before and after contrast administration.
There were no side effects after contrast administration. The mean number of LV segments visualised after CE increased from 8.0 ± 4 to 16.9 ± 0.1 in all patients (52.4% of improvement); 272 (52.3%) out of 510 segments were described as poorly visible using standard TTE while only four (0.8%) segments were not visible after contrast administration. Out of all visible hypokinetic, akinetic and dyskinetic segments, 63 (12%) segments were classified wrongly. The LV volumes were smaller and LVEF significantly higher after CE compared to standard TTE (LVEDV 127 mL vs 98 mL; LVESV 65 mL vs 45 mL; p = 0.0002 and p = 0.0016, respectively). In all methods used: visual, Simpson's method and biplane method, LVEF was significantly higher compared to standard TTE (p = 0.012, p = 0.0088, p = 0.00065, respectively). In patients after surgical LV restoration, CE enabled the assessment of LV geometry, patch localisation and the exclusion of the presence of LV thrombus.
Contrast echocardiography is a rapid, simple and safe technique when performed at bedside in a cardiosurgery post-operative unit setting, permitting accurate both segmental and global wall motion analysis. The use of contrast echocardiography could help to identify causes leading to LV systolic dysfunction immediately after CABG surgery.
心肌声学造影（CE）可提高标准超声心动图的质量。冠状动脉旁路移植术（CABG）后早期 CE 的价值尚未得到充分证实。
在心脏外科术后单元（CPU）中，评估 CE 在评估 CABG 后患者左心室（LV）功能方面的准确性和安全性，并与传统经胸超声心动图（TTE）进行比较。
在 CPU 中治疗后，对 30 例 TTE 技术困难的 CABG 患者连续进行 SonoVue（意大利 Bracco）超声造影剂检查。通过可分析的 LV 节段数量评估超声心动图成像质量的改善。在给药前后计算 LV 舒张末期和收缩末期容积（LVEDV、LVESV）和 LV 射血分数（LVEF）。
造影后无副作用。CE 后，所有患者的 LV 节段可视数量从 8.0±4 增加到 16.9±0.1（增加 52.4%）；272 个（52.3%）510 个节段用标准 TTE 描述为可视性差，而造影后仅 4 个（0.8%）节段不可视。在所有可运动、局部运动和运动不良的节段中，有 63 个（12%）节段被错误分类。与标准 TTE 相比，LV 容积更小，LVEF 显著升高（LVEDV 127 mL 比 98 mL；LVESV 65 mL 比 45 mL；p=0.0002 和 p=0.0016）。在所有使用的方法中：视觉、辛普森法和双平面法，与标准 TTE 相比，LVEF 均显著升高（p=0.012、p=0.0088、p=0.00065）。在接受手术 LV 修复的患者中，CE 能够评估 LV 几何形状、补片定位和排除 LV 血栓形成的存在。
在心脏外科术后单元环境中床边进行时，CE 是一种快速、简单、安全的技术，可准确进行节段和整体壁运动分析。CE 的使用可以帮助确定 CABG 手术后导致 LV 收缩功能障碍的原因。
