Myocardial perfusion measurement by contrast echocardiography in congenital heart disease

Abstract

Altered myocardial perfusion is frequent in patients with congenital heart disease. Measurement of myocardial blood flow per gram of myocardium at rest and during hyperemia is the most robust method to evaluate myocardial perfusion in absolute terms. So far, most studies in congenital heart disease patients used positron emission tomography to evaluate absolute myocardial blood flow. With the recent advances in contrast echocardiography, we have now a more easily applicable but similarly solid method at hand to assess myocardial perfusion in different clinical scenarios. Myocardial contrast echocardiography has proven its clinical and scientific value in coronary artery disease patients. In this review, we discuss the merits of myocardial perfusion assessment in patients with a systemic right ventricle, a univentricular heart physiology, and tetralogy of Fallot. We outline how myocardial contrast echocardiography can improve our understanding of ventricular function. We have to admit that its clinical value remains to be elucidated. For most congenital defects, the impact of impaired myocardial perfusion on ventricular function and clinical outcome is still poorly investigated. Myocardial contrast echocardiography can contribute to fill this gap.