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Query: UMLS:C0002962 (angina)
 21,142 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The present case will focus on the potential of hypoperfusion detection with myocardial contrast echocardiography (MCE) using power Doppler harmonic imaging (PDHI). PDHI is normally performed in a triggered mode. Microbubbles were destroyed by the ultrasound energy in the myocardium, and myocardium has to be refilled with microbubbles within the time interval between the ultrasound pulses to obtain repetitive information about perfusion. Using the contrast agent Levovist, however, real-time PDHI also results in myocardial opacification presumably due to perfusion signals of the arteriolar microbubble passage. A 45-year-old woman with typical stress-induced angina was admitted to our department for cardiac catheterization. Prior to the angiography a conventional echocardiogram showed normal left ventricular function. Tissue Doppler, however, demonstrated postsystolic longitudinal shortening of the septal, anterior, and lateral wall regions. Myocardial contrast echocardiography with triggered PDHI showed complete opacification of the myocardium at rest. Using real-time PDHI with Levovist, the septum could not be opacified. The consecutive angiography documented a severe unprotected main coronary artery stenosis. After angioplasty and stent implantation, MCE measurements were repeated. Repetitive intravenous bolus injections of Optison during triggered PDHI showed no differences to the investigation prior to the angioplasty. Using real-time PDHI with Levovist, however, there was a marked difference in comparison to the pre-interventional analysis. A complete opacification of the apical septum was observed. The present case suggests that different MCE techniques can analyze different compartments of the myocardial vasculature in clinical practice. This methodological comparison between triggered and real-time PDHI shows obviously differences in the DI signal detection due to the different microbubble behavior. Clinicians should be aware of the potentials of MCE to improve noninvasive diagnostic procedures in patients with ischemic heart disease.
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PMID:Myocardial contrast echocardiography for assessment of myocardial perfusion at rest in a patient with left main coronary artery stenosis. 1457 53

We describe the first reported case of a saphenous vein graft aneurysm mimicking a left atrial (LA) mass on echocardiographic imaging in a 62-year-old man 22 years after coronary bypass surgery. On presentation with worsening angina, a transthoracic echocardiogram revealed a LA mass. Coronary angiography showed severe native coronary artery and graft disease. The saphenous vein graft to the first obtuse marginal branch of the left circumflex coronary artery appeared ectatic and aneurysmal and was diffusely diseased. Transesophageal echocardiography demonstrated a well-circumscribed mass apparently within the LA, with an area of central echolucency and a surrounding crescentic region of increased echodensity, with absent flow by color and spectral Doppler techniques. After an intravenous bolus injection of Definity, the area of central echolucency within the mass was opacified compatible with a vascular origin. Pulsatile contrast flow was seen predominantly in diastole consistent with a coronary arterial flow pattern. Thus, contrast transesophageal echocardiography confirmed the diagnosis of a saphenous vein graft aneurysm invaginating the lateral aspect of the LA, mimicking a true LA mass, highlighting a novel use for this technology.
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PMID:Saphenous vein graft aneurysm masquerading as a left atrial mass: diagnosis by contrast transesophageal echocardiography. 1805 3