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European Journal of Echocardiography Advance Access originally published online on June 11, 2009
European Journal of Echocardiography 2009 10(6):808-810; doi:10.1093/ejechocard/jep075
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Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2009. For permissions please email: journals.permissions@oxfordjournals.org

Direct visualization of septal perforator coronary arterial blood flow during perflutren microsphere contrast echocardiography

David Platts*, Cathy West, Tau Boga, Christian Hamilton-Craig and Darryl Burstow

Echocardiography Department, The Prince Charles Hospital, Rode Rd., Chermside, Brisbane, QLD 4051, Australia

Received 1 February 2009; accepted after revision 16 May 2009; online publish-ahead-of-print 11 June 2009.

* Corresponding author. Tel: +61 7 31394000. E-mail address: dgplatts{at}hotmail.com


  Abstract

A 62-year-old female with supraventricular tachycardia underwent a contrast echocardiogram to assess left ventricular structure and function due to sub-optimal images on conventional imaging. Multi-pulse, phase inversion, low mechanical index imaging was used (left ventricular opacification), combined with bolus dosing of a perflutren microsphere (Definity®). In the parasternal short-axis view, during contrast imaging, flow within a septal coronary artery could be directly visualized. The corresponding coronary angiogram demonstrated prominent septal perforators arising from the LAD artery. By exploiting the non-linear oscillation properties of microbubbles and the linear oscillation properties of tissue, at low MI, contrast-specific imaging has the ability to enhance the contrast signal while suppressing the myocardial signal. This form of contrast imaging has high temporal and spatial resolution, enabling visualization of relatively small structures in real time. Clinical relevance of this finding includes the ability to enhance coronary blood flow evaluation, which would have utility in those studies where spectral Doppler is being used to evaluate coronary blood flow and coronary flow reserve and it may be beneficial in the identification of septal perforator arteries that should be injected with alcohol during percutaneous septal ablation for the management of hypertrophic obstructive cardiomyopathy.

Keywords: Contrast echocardiography; Left ventricular opacification; Low mechanical index; Septal coronary artery


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