IMPROVEMENT OF PULMONARY VENOUS FLOW DOPPLER SIGNAL AFTER INTRAVENOUS-INJECTION OF LEVOVIST

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 now pattern, the assessment of left ventric ular diastolic dysfunction. In approximately one third of the cases, h owever, transthoracic ultrasonography is not able to record an adequat ely analyzable pulmonary venous flow pattern. The aim of the study was to examine and compare the effect of the echo-enhancing agent Levovis t on the pulsed-wave Doppler flow quality of the transthoracic (TTE) a nd transesophageal (TEE) recorded pulmonary venous flow. In 26 consecu tive patients a qualitative (score system) and quantitative analysis o f pulmonary venous flow pattern was obtained before and after peripher al venous injection of Levovist at concentrations of 200 mg/ml (low do se) and 400 mg/ml (high dose). The amount of measurable studies for th e antegrade pulmonary venous now increased after the injection of Levo vist from 85% to 96% for TTE and from 96% to 100% for TEE. The retrogr ade flow as seen by TTE was adequately analyzable in only 46% before a nd in 73% after the injection of Levovist (p < 0.02). Before any contr ast enhancement the retrograde pulmonary venous flow recorded by TEE c ould be analyzed in 77% of the patients, with the percentage increasin g to 88% and 92% after the administration of a low and high dose of Le vovist, respectively (p < 0.05). In particular, the quality score of t he retrograde 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 pul sed-wave Doppler interrogation by TTE without Levovist underestimated the velocities of the antegrade and retrograde pulmonary venous flow. After Levovist was administered, the recorded values were comparable t o those obtained by TEE. An analogous pattern is encountered when quan tifying the duration of the retrograde flow component. Thus the periph eral venous injection of Levovist leads to an improved quality of the pulmonary venous flow Doppler signal recorded by TTE. On qualitative a nd quantitative evaluation the values recorded by TTE after administra tion of Levovist are comparable to those of the TEE technique without an echo-enhancing agent.