Incorporating ultrasound contrast in the laboratory: A series on contrast echocardiography, article 1

Abstract

Contrast echocardiography, in the form of agitated saline solution, has been routinely performed for more than 30 years. Because these large and fragile microbubbles do not pass through the pulmonary circulation, they are visible only on the right side of the heart and are typically used to rule out an atrial level shunt. Recent advances in second-generation agents have produced smaller and more stable microbubbles that can pass through the pulmonary circulation intact and that now can provide left ventricular (LV) opacification with a peripheral intravenous injection. As the number of Food and Drug Administration–approved ultrasonographic (ultrasound) contrast agents increases, contrast echocardiography will continue to move at an increasing pace from research laboratories to routine clinical use. There is more to the successful implementation of contrast than simply ordering a few vials of an agent. New challenges exist for the cardiac sonographer, as well as other team members, as ultrasound contrast echocardiography moves into routine clinical use. In this first in a series of articles, basic information regarding what laboratories need to integrate contrast echocardiography will be discussed in detail.