H. Lambertz et al., IMPROVEMENT OF PULMONARY VENOUS FLOW DOPP LER SIGNAL AFTER INTRAVENOUS-INJECTION OF LEVOVIST, Zeitschrift fur Kardiologie, 86(10), 1997, pp. 839-847
The analysis of the pulmonary venous flow Doppler pattern can assist i
n the determination of the severity of mitral regurgitation and, in co
njunction with transmitral flow pattern, the assessment of left ventri
cular diastolic dysfunction. In about one third of the cases, however,
transthoracic ultrasonography is not able to record an adequately ana
lyzable pulmonary venous flow pattern. The aim of the study was to exa
mine and compare the effect of the echo-enhancing agent Levovist on th
e pulsed-wave Doppler flow quality of the transthoracically (TTE) and
trans-esophageally (TEE) recorded pulmonary venous flow. In 26 consecu
tive patients, a qualitative (score system) and quantitative analysis
of the pulmonary venous flow pattern was obtained before and after per
ipheral venous injection of Levovist at concentrations of 200 mg/ml (l
ow dose) and 400 mg/ml (high dose). The number of measurable studies f
or the antegrade pulmonary venous flow increased after Levovist from 8
5 % to 96 % for TTE and from 96 % to 100 % for TEE. The retrograde flo
w as seen by TTE was adequately analyzable in only 45 % before and in
73 % after injection of Levovist (p < 0.02). Before any contrast enhan
cement, the retrograde pulmonary venous flow recorded by TEE could be
analyzed in 77 % of the patients with the percentage increasing to 88
% and 92 % after administration of a low and high dose of Levovist, re
spectively (p < 0.05). In particular, the quality score of the retrogr
ade flow was significantly altered by the administration of Levovist (
increase from 1.8 +/- 1.0 to 2.6 +/- 1.1 (low dose Levovist), p < 0.05
and to 2.7 +/- 1.3 (high dose Levovist), p < 0.05). The pulsed-wave D
oppler evaluation by TTE without Levovist underestimated the velocitie
s of the antegrade and retrograde pulmonary venous flow. After adminis
tration of Levovist, the recorded values are comparable to those obtai
ned by TEE. An analogous pattern is encountered when quantifying the d
uration of the retrograde now component. Thus, the peripheral venous i
njection of Levovist leads to an improved quality of the pulmonary ven
ous flow Doppler signal recorded by TTE. Qualitatively and quantitativ
ely the values recorded by TTE after administration of Levovist are co
mparable to those of the TEE technique without an echo-enhancing agent
.