IMPROVEMENT OF PULMONARY VENOUS FLOW DOPP LER SIGNAL AFTER INTRAVENOUS-INJECTION OF LEVOVIST

Citation
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
Citations number
30
Categorie Soggetti
Cardiac & Cardiovascular System
Journal title
ISSN journal
03005860
Volume
86
Issue
10
Year of publication
1997
Pages
839 - 847
Database
ISI
SICI code
0300-5860(1997)86:10<839:IOPVFD>2.0.ZU;2-Y
Abstract
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 .