Contrast Echocardiogram for the Evaluation of Streaming in a Single-Ventricle Patient


In cases involving single ventricles, predicting streaming characteristics is difficult. Unfavorable streaming can cause decreased oxygen saturation. Judging whether desaturation results from decreased pulmonary flow or unfavorable streaming is critical. A 20-day-old infant with a single left ventricle underwent ductus arteriosus ligation and pulmonary artery banding to control high pulmonary flow. Severe desaturation presented postoperatively, which worsened to 68% despite pure-oxygen ventilation. A bedside contrast echocardiogram helped determine whether unfavorable streaming caused desaturation. It revealed systemic venous streaming predominantly directed to the aorta. Emergent balloon atrial septostomy facilitated mixing at the atrial level. Oxygen saturation promptly increased to 85%.

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  1. 1.

    Tharakan JA (2011) Admixture lesions in congenital cyanotic heart disease. Ann Pediatr Cardiol 4(1):53–59

    Article  PubMed  PubMed Central  Google Scholar 

  2. 2.

    Rahimtoola SH, Ongley PA, Swan HJ (1966) The hemodynamics of common (or single) ventricle. Circulation 34(1):14–23

    Article  CAS  PubMed  Google Scholar 

  3. 3.

    Macartney FJ et al (1976) Common or single ventricle. An angiocardiographic and hemodynamic study of 42 patients. Circulation 53(3):543–554

    Article  CAS  PubMed  Google Scholar 

  4. 4.

    Meyer SL et al (2017) Intracardiac anatomical relationships and potential for streaming in double inlet left ventricles. PLoS ONE 12(11):e0188048

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  5. 5.

    Van Hare GF, Silverman NH (1989) Contrast two-dimensional echocardiography in congenital heart disease: techniques, indications and clinical utility. J Am Coll Cardiol 13(3):673–686

    Article  PubMed  Google Scholar 

  6. 6.

    Rizzo M et al (2005) The feasibility and usefulness of contrast exercise echocardiography for the assessment of left ventricular function in master athletes. Eur J Echocardiogr 6(1):24–30

    Article  PubMed  Google Scholar 

  7. 7.

    Chiu AH, Haluszkiewicz E, McAuliffe W (2014) Micro-bubble transcranial Doppler ultrasound for exclusion of right-to-left circulatory shunts: why should we provide the service? J Med Imaging Radiat Oncol 58(4):464–468

    PubMed  Google Scholar 

  8. 8.

    Wong J et al (2014) Streaming in transposition of the great arteries by using cardiac magnetic resonance imaging. Circulation 129(10):1169–1170

    Article  PubMed  PubMed Central  Google Scholar 

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Correspondence to Shinya Miura.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Miura, S., Ookoshi, Y., Momoki, K. et al. Contrast Echocardiogram for the Evaluation of Streaming in a Single-Ventricle Patient. Pediatr Cardiol 40, 216–218 (2019).

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  • Congenital cardiac disease
  • Echocardiography
  • Echocardiogram
  • Admixture
  • Unfavorable streaming
  • Ultrasound