EVALUATION OF POSTINFARCTION VIABLE MYOCARDIUM AT JEOPARDY BY DOBUTAMINE ECHOCARDIOGRAPHY AND MYOCARDIAL CONTRAST ECHOCARDIOGRAPHY

Both myocardial contrast echocardiography (MCE), obtained by intracoro nary injection of sonicated Ioxaglate, and dobutamine echocardiography (DE) were performed before and after percutaneous transluminal corona ry angioplasty (PTCA) in a patient with recent myocardial infarction, an occluded infarct related artery (IRA) and collateral flow. An oppos ite response to low and high dose dobutamine (increase and decrease in regional contractility, respectively) suggested the presence of viabl e myocardium at jeopardy in the infarcted area. This myocardial area w as exclusively perfused by collateral circulation (demonstrated by MCE ) supplied by an angiographically normal left coronary artery. After P TCA, right coronary artery flow was re-established and angiographicall y demonstrated collateral flow disappeared. MCE showed a normal right coronary artery perfusion bed and relevant overlap areas after left co ronary MCE injection. Dobutamine echocardiography performed after PTCA demonstrated persistence of viability, but disappearence of myocardia l ischemia.