Contrast Echocardiography in Valvular Regurgitation

Abstract

For the first few years after the introduction of contrast echocardiography by Gramiak, its use was limited to structure identification and shunt detection. In 1974, Kerber reported the use of an ultrasonic contrast method in the diagnosis of valvular regurgitation and intracardiac shunts [1]. He noticed contrast appearing in the left atrium after left ventricular injection in 14 out of 16 patients with mitral regurgitation, and in the left ventricle after aortic root injections in 13 out of 16 patients with aortic regurgitation. Valvular regurgitation as low as 10%, according to angiographic calculations, was detected by this method. One false positive study due to catheter-induced mitral regurgitation was noted. The authors concluded that M-mode ultrasonic monitoring of catheter injections distal to a regurgitant valve is a sensitive and specific — though qualitative — technique for detecting valvular regurgitation. Other laboratories, including our own, have confirmed that intracardiac injections during catheterization can be monitored by echocardiography and that this is a sensitive method for the detection of valvular regurgitation. Little further work has been reported in this area, and this invasive technique probably has only limited applications in the occasional patient where there is a strong contraindication to the use of ionizing radiation, for example in early pregnancy [2].