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Lashin H, Olusanya O, Smith A, Bhattacharyya S. Ultrasound-Enhancing Agent Safely Enhances Left Ventricular Visualization by Transthoracic Echocardiography in Patients on ECMO Support. J Cardiothorac Vasc Anesth 2024; 38:133-140. [PMID: 37940458 DOI: 10.1053/j.jvca.2023.10.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/06/2023] [Accepted: 10/09/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The authors investigated if the use of ultrasound-enhancing agents (UEA) can safely improve left ventricular (LV) image quality by transthoracic echocardiography (TTE) in patients on extracorporeal membrane oxygenation (ECMO). DESIGN AND SETTING This study was performed in a tertiary cardiothoracic and ECMO center in London, United Kingdom. PARTICIPANTS The authors included 18 prospectively identified consecutive patients requiring TEE supported on peripherally implanted ECMO. INTERVENTION AND MEASUREMENTS TTE was performed before and after the UEA administration. The authors assessed the LV image quality using the biplane (apical-4-chamber and apical-2-chamber views) endocardial border definition index (1 = good, 2 = suboptimal, 3 = poor, and 4 = unavailable), as well as the feasibility of LV ejection fraction (LVEF) measurement. The authors also gathered sequential clinical information for the next 24 hours. MAIN RESULTS The patients' median age was 47 years (35, 65), and 5 (28%) were women. The biplane endocardial border definition index improved from the suboptimal to the good range (2.167 [1.812, 3.042] v 1.500 [1.417, 1.792], p = 0.0004) after the use of UEA. The feasibility of LVEF tripled from 25% (n = 5) to 83% (n = 15) (p = 0.0008) with UEA use. The UEA did not set off the bubble alarm and did not impact clinical or ECMO parameters. CONCLUSION The use of UEA significantly improved the quality of LV biplane images by transthoracic echocardiography, transforming them from suboptimal to good in patients supported with peripherally implanted ECMO. UEA use tripled the feasibility of measuring LVEF by TTE without affecting clinical and ECMO parameters.
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Affiliation(s)
- Hazem Lashin
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom.
| | - Olusegun Olusanya
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
| | - Andrew Smith
- Adult Critical Care Unit, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom
| | - Sanjeev Bhattacharyya
- William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, United Kingdom; Cardiology Department, Barts Heart Centre, St Bartholomew's Hospital, West Smithfield, London, United Kingdom
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Chaszczewski KJ, Linder JR, Campbell MJ, Convery M, Wang Y, Smith CL, Kozyak BW, Quartermain MD. Novel Utilization of Ultrasound Enhancing Agents in Complex Congenital Heart Disease Following Superior Cavopulmonary Connection. J Am Soc Echocardiogr 2023; 36:516-522. [PMID: 36642236 DOI: 10.1016/j.echo.2023.01.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 01/09/2023] [Accepted: 01/09/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Children with single-ventricle congenital heart disease typically undergo a superior cavopulmonary connection (SCPC) as the second stage in their surgical palliation. Postoperatively, stenoses of the SCPC and branch pulmonary arteries can occur. If there are clinical concerns and echocardiography is insufficient for diagnosis, patients undergo invasive evaluation with exposure to radiation and anesthesia. The use of ultrasound enhancing agents (UEAs) to improve echocardiographic diagnostic capabilities has not previously been described in this population. METHODS A single-center, retrospective case review was conducted of children who underwent echocardiography with UEA, following SCPC, from March 1, 2020, to April 15, 2022, at the Children's Hospital of Philadelphia. Twenty-two patients with hypoxemia or concern for obstruction following SCPC underwent UEA echocardiography. Extracted clinical data included patient demographics, echocardiographic images, angiography, surgical and transcatheter interventions, as well as available follow-up data. RESULTS Six of the 22 UEA echocardiograms demonstrated stenosis or occlusion of either the SCPC or a pulmonary artery. All six patients underwent cardiac catheterization and five required intervention. Angioplasty was performed in each case with one requiring subsequent surgical revision. Sixteen of 22 UEA echocardiograms demonstrated no evidence of stenosis. Ten of these 16 patients improved, while six experienced persistent hypoxemia prompting referral for cardiac catheterization. Angiography confirmed the UEA echocardiographic findings (absence of stenosis) in four of these six patients. There were no adverse reactions related to UEA administration. CONCLUSIONS Echocardiography with UEAs is a valuable and safe adjunctive imaging modality following SCPC, particularly when two-dimensional and color imaging is limited. This novel application of UEAs in complex patients with congenital heart disease provides an "angiogram-like" image, better delineating vessel walls and improving assessment of postoperative obstruction. As experience with UEAs increases in the congenital heart disease population, there may be opportunities to decrease invasive and costly procedures, while expediting the care of patients in need of intervention.
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Affiliation(s)
- Kasey J Chaszczewski
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin; Section of Pediatric Cardiology, The Herma Heart Institute, Milwaukee, Wisconsin
| | - Jarett R Linder
- Division of Pediatric Cardiology, Ann & Robert H. Lurie Children's Hospital, Chicago, Illinois; Feinberg School of Medicine, Northwestern University, Chicago, Illinois
| | - Matthew J Campbell
- Division of Pediatric Cardiology, Nemours Children's Hospital, Wilmington, Delaware
| | - Michael Convery
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Yan Wang
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Christopher L Smith
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Benjamin W Kozyak
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania; Division of Cardiac Critical Care Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Michael D Quartermain
- Division of Cardiology, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.
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Cinelli M, Karam B, Spagnola J, Assaad M, Salmane C, Hoyek W, Schwartz C. Use of Lumason Contrast Echocardiography in Post-myocardial Infarction Ventricular Septal Defect. Cureus 2022; 14:e27128. [PMID: 36004020 PMCID: PMC9392834 DOI: 10.7759/cureus.27128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/21/2022] [Indexed: 11/05/2022] Open
Abstract
We report herein the case of an elderly female who presented with myocardial infarction complicated by ventricular septal defect (VSD) that was evident on cardiac auscultation and contrast echocardiography using Lumason® (Bracco Diagnostics Inc, Monroe Township, USA). Patient underwent surgical repair for her VSD post-infarct along with coronary artery bypass grafting after being treated for cardiogenic shock. We also highlight the management strategies in patients with similar complications. In this report, we shed the light on the importance of using Lumason contrast for the identification of shunt and for the diagnosis of VSD. Lumason contrast is widely available and licensed.
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Azarine A, Scalbert F, Garçon P. Cardiac functional imaging. Presse Med 2022; 51:104119. [PMID: 35321846 DOI: 10.1016/j.lpm.2022.104119] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 01/27/2022] [Accepted: 03/11/2022] [Indexed: 01/01/2023] Open
Abstract
During the last 20 years, cardiac imaging has drastically evolved. Positron emission tomography (PET), fast three-dimensional (3D) imaging with the latest generations of echocardiography & multi-detector computed tomography (CT), stress perfusion assessed by magnetic resonance imaging (MRI), blood flow analysis using four-dimensional (4D) flow MRI, all these techniques offer new trends for optimal noninvasive functional cardiac imaging. Dynamic functional imaging is obtained by acquiring images of the heart at different phases of the cardiac cycle, allowing assessment of cardiac motion, function, and perfusion. Between CT and Cardiac MRI (CMR), CMR has the best temporal resolution, which is suitable for functional imaging while cardiac CT provides higher spatial resolution with isotropic data that have an identical resolution in the three dimensions of the space. The latest generations of CT scanners enable whole heart assessment in one beat, offering also an acceptable temporal resolution with the possibility to display the images in a dynamic mode. Another rapidly growing technique using functional and molecular imaging for the assessment of biological and metabolic pathways is the PET using radio-labeled tracers. Meanwhile, the oldest cardiac imaging tool with doppler ultrasound technology has never stopped evolving. Echocardiography today performs 3D imaging, stress perfusion, and myocardial strain assessment, with high temporal resolution. It still is the first line and more accessible exam for the patient. These different modalities are complementary and may be even combined into PET-CT or PET-MRI. The ability to combine the functional/molecular data with anatomical images may implement a new dimension to our diagnostic tools.
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Affiliation(s)
- Arshid Azarine
- Radiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France.
| | - François Scalbert
- Nuclear Medecine Department, Hôpital Bichat-Claude Bernard, 46 rue Henri Huchard, 75877, Paris, France
| | - Philippe Garçon
- Cardiology Department, Groupe Hospitalier Paris Saint-Joseph, 185, Rue Raymond Losserand, 75014, Paris, France
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Gumus M, Oommen KC, Squires JH. Contrast-enhanced ultrasound of the neonatal brain. Pediatr Radiol 2022; 52:837-846. [PMID: 34333692 DOI: 10.1007/s00247-021-05157-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 06/03/2021] [Accepted: 07/12/2021] [Indexed: 12/13/2022]
Abstract
Cranial US is an integral component of evaluating the neonatal brain, especially in the setting of critically ill infants and in the emergency setting, because cranial US can be performed portably at the bedside, is safe, and can be repeated whenever needed. Contrast-enhanced ultrasound (CEUS) involves intravenously injecting microbubbles to allow for improved visibility of large and small vessels to assess vascularity and is becoming a widespread technique to improve diagnostic performance of US across a broad spectrum of applications. CEUS has the potential to add value to routine brain US and become a useful adjunct to MRI in infants in need of bedside imaging. In this review we describe the basics of US contrast agents and CEUS technique, including safety considerations, and detail the potential clinical uses of brain CEUS.
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Affiliation(s)
- Memduha Gumus
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Kevin C Oommen
- University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Judy H Squires
- Department of Radiology, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
- Department of Pediatric Radiology, UPMC Children's Hospital of Pittsburgh, 2nd Floor Radiology, 4401 Penn Ave., Pittsburgh, PA, 15224, USA.
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Lashin H, Shepherd S, Smith A. Contrast-Enhanced Echocardiography Application in Patients Supported by Extracorporeal Membrane Oxygenation (ECMO): A Narrative Review. J Cardiothorac Vasc Anesth 2021; 36:2080-2089. [PMID: 34074555 DOI: 10.1053/j.jvca.2021.04.031] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 03/25/2021] [Accepted: 04/20/2021] [Indexed: 11/11/2022]
Abstract
Extracorporeal membrane oxygenation (ECMO) is a lifesaving intervention increasingly used to support patients with severe respiratory and cardiac dysfunction. Echocardiography is an important tool, aiding implantation and monitoring during ECMO therapy, but often its use is limited by poor acoustic windows. This limitation may be overcome by the use of echocardiography contrast agents to improve diagnostic yield and reduce the need for other imaging modalities that may require patient transfer, involve ionizing radiation and, occasionally, nephrotoxic radio-opaque contrast medium. In this article the authors review the literature addressing the use of contrast-enhanced echocardiography (CEE) in ECMO-supported patients. The authors discuss the role of CEE in guiding implantation of ECMO, cardiac assessment and diagnosis of complications during ECMO therapy, as well as the safety of ultrasound-enhancing agents in this cohort of patients.
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Affiliation(s)
- Hazem Lashin
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, England, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, England, United Kingdom.
| | - Stephen Shepherd
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, England, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, England, United Kingdom
| | - Andrew Smith
- Adult Critical Care Unit, Barts Heart Centre, St. Bartholomew's Hospital, West Smithfield, London, England, United Kingdom; William Harvey Research Institute, Barts, and the London School of Medicine and Dentistry, Queen Mary University of London, Charterhouse Square, London, England, United Kingdom
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Contrast-Enhanced Ultrasound in Children: Implementation and Key Diagnostic Applications. AJR Am J Roentgenol 2021; 217:1217-1231. [PMID: 33908269 DOI: 10.2214/ajr.21.25713] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Contrast-enhanced ultrasound (CEUS) utilization is expanding rapidly, particularly in children, in whom the modality offers important advantages of dynamic evaluation of the vasculature, portability, lack of ionizing radiation, and lack of need for sedation. Accumulating data establish an excellent safety profile of ultrasound contrast agents in children. Although only FDA-approved for IV use in children for characterizing focal liver lesions and for use during echocardiography, growing off-label applications are expanding the diagnostic potential of ultrasound. Focal liver lesion evaluation is the most common use of CEUS, and the American College of Radiology Pediatric LI-RADS Working Group recommends including CEUS for evaluation of a newly discovered focal liver lesion in many circumstances. Data also support the role of CEUS in hemodynamically stable children with blunt abdominal trauma, and CEUS is becoming a potential alternative to CT in this setting. Additional potential applications that require further study include evaluation of pathology in the lung, spleen, brain, pancreas, bowel, kidney, female pelvis, and scrotum. This review explores the implementation of CEUS in children, describing basic principles of ultrasound contrast agents and CEUS technique and summarizing current and potential IV diagnostic applications based on pediatric-specific supporting evidence.
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Tirrell TF, Demehri FR, McNamara ER, Paltiel HJ, Barnewolt CE, Padua HM, Chow JS, Dickie BH. Contrast enhanced colostography: New applications in preoperative evaluation of anorectal malformations. J Pediatr Surg 2021; 56:192-195. [PMID: 33143879 DOI: 10.1016/j.jpedsurg.2020.09.033] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Understanding details of anatomic relationships between the colon and surrounding structures is a critical piece of preoperative planning prior to surgical repair of anorectal malformations (ARMs). Traditional imaging techniques involve ionizing radiation, distention of the rectum with supraphysiologic intraluminal pressures, and sometimes require sedation. Recent developments in the field of contrast agents have allowed the emergence of an ultrasound-based technique that can avoid these requirements while continuing to provide high resolution structural information in three dimensions. METHODS Fourteen children (13 male, 1 female, age 1-11 months) with ARMs underwent contrast enhanced colostography (ceCS) in addition to traditional preoperative imaging techniques to delineate anatomic relationships of pelvic structures. RESULTS ceCS and traditional imaging yielded concordant anatomic information, including structural relationships and fistulous connections, in 10/14 patients (71%). ceCS detected fistulous connection in 2/13 patients (15%) that were not seen by traditional imaging. Ultrasonography failed to detect the fistulous connection in one patient. CONCLUSIONS ceCS is a safe, effective and flexible method for defining important structural information in ARM patients. When compared with traditional methods, it provided equivalent or superior results 93% of the time and bears consideration as a standard tool in preoperative planning for this population. TYPE OF STUDY Retrospective Comparative Study. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Timothy F Tirrell
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Fegan 3, Boston, MA, USA, 02115
| | - Farokh R Demehri
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Fegan 3, Boston, MA, USA, 02115
| | - Erin R McNamara
- Department of Urology, Boston Children's Hospital, 300 Longwood Ave, Hunnewell 3, Boston, MA, USA, 02115
| | - Harriet J Paltiel
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA, 02115
| | - Carol E Barnewolt
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA, 02115
| | - Horacio M Padua
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA, 02115
| | - Jeanne S Chow
- Department of Radiology, Boston Children's Hospital, 300 Longwood Ave, Boston, MA, USA, 02115
| | - Belinda H Dickie
- Department of Surgery, Boston Children's Hospital, 300 Longwood Ave, Fegan 3, Boston, MA, USA, 02115.
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Sztechman D, Żera T, Czarzasta K, Wojciechowska M, Szczepańska-Sadowska E, Cudnoch-Jędrzejewska A. Transthoracic echocardiography: from guidelines for humans to cardiac ultrasound of the heart in rats. Physiol Meas 2020; 41:10TR02. [PMID: 33164918 DOI: 10.1088/1361-6579/abb3a3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Ultrasound examination of the heart is a cornerstone of clinical evaluation of patients with established or suspected cardiovascular conditions. Advancements in ultrasound imaging technology have brought transthoracic echocardiography to preclinical murine models of cardiovascular diseases. The translational potential of cardiac ultrasound is critically important in rat models of myocardial infarction and ischemia-reperfusion injury, congestive heart failure, arterial hypertension, cardiac hypertrophy, pulmonary hypertension, right heart failure, Takotsubo cardiomyopathy, hypertrophic and dilated cardiomyopathies, developmental disorders, and metabolic syndrome. Modern echocardiographic machines capable of high-frame-rate image acquisition and fitted with high-frequency transducers allow for cardiac ultrasound in rats that yields most of the echocardiographic measurements and indices recommended by international guidelines for cardiac ultrasound in human patients. Among them are dimensions of cardiac chambers and walls, indices of systolic and diastolic cardiac function, and valvular function. In addition, measurements of cardiac dimensions and ejection fraction can be significantly improved by intravenous administration of ultrasound enhancing agents (UEAs). In this article we discuss echocardiography in rats, describe a technique for minimally invasive intravenous administration of UEAs via the saphenous vein and present a step-by-step approach to cardiac ultrasound in rats.
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Affiliation(s)
- Dorota Sztechman
- Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097 Warsaw, Poland
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