Developments in Cardiovascular Medicine

1. Introduction and general background.- 1. Evolution of echo contrast concepts.- 2. Assessment of cardiac structures and flow patterns.- 3. Development of echo contrast agents.- 4. Consideration of echo contrast mechanism and safety.- References.- 2. Development and validation of MC-2DE methodology.- 1. Initial exploration of MC-2DE and its validity.- 2. Characteristics and studies of myocardial echo contrasts.- 3. Echo contrast safety and toxicity.- 4. Transpulmonary echo contrast investigations.- 5. Quantitative MC-2DE methods and their limitations.- 6. MC-2DE measurement of ischemic risk area and infarcts.- 7. Assessment of coronary stenosis and myocardial blood flow.- 8. Physiological studies and miscellaneous MC-2DE applications.- 9. Initial clinical MC-2DE reports.- 10. Potential surgical application of MC-2DE.- References.- 3. Contrast agents for myocardial perfusion studies: Mechanisms, state of the art, and future prospects.- 1. Introduction.- 2. The source of ultrasonic contrast effect.- 3. Physical influences on ultrasonic contrast effect.- 3.1 Viscosity.- 3.2 Surfactant properties.- 3.3 Influence of pH.- 4. Specific agents reported as echocardiographic contrast agents.- 4.1 Carbon dioxide.- 4.2 Hydrogen peroxide.- 4.3 In vivo generation of contrast.- 4.4 Contrast formed by bubbles in gelatin or Haemaccel(R).- 4.5 Saccharide particles as ultrasound contrast agents.- 4.6 Heavy liquids: Fluorochemicals and fat emulsions.- 4.7 Highly viscous solutions.- 4.8 Sonicated albumin microbubble suspensions.- 5. The use of high intensity sonication for microbubble creation.- 5.1 Background.- 5.2 Animal studies using sonicated albumin.- 5.3 Human studies using sonicated albumin.- 6. Conclusion.- Acknowledgements.- References.- 4. Significance and selection of contrast solution for myocardial contrast echocardiography.- 1. Introduction.- 2. Current echo contrast media.- 3. Properties of the ECM: Microbubble size, osmolality, viscosity, and stability.- 3.1 Microbubble size.- 3.1.1 Preparation of the microbubbles.- 3.1.2 Physicochemical properties and effects on bubble size.- 3.1.3 Effects of microbubble size on myocardial perfusion.- 3.2 Osmolality, viscosity, and stability of the mixture of carrier solution and microbubbles.- 4. Evaluation of the echo contrast media used so far.- 5. Echo contrast safety and effectiveness.- 6. Some conclusions.- Acknowledgements.- References.- 5. Side effects and potential toxicity of myocardial contrast echo Cardiography.- 1. Introduction.- 2. Possible mechanisms of toxicity.- 2.1 Adverse effects related to contrast media.- 2.2 Adverse effects related to microbubbles: Capillary plugging.- 2.3 Cavitation/resonance and ultrasonic effects.- 2.4 Side effects related to injection technique.- 2.5 Patient related adverse effects.- 3. Animal studies.- 4. Human experience.- 5. Conclusions.- References.- 6. Ischemic 'risk area' determination using myocardial contrast two-dimensional echocardiography.- 1. What is the 'risk area'?.- 2. What is the significance of the 'risk area' ?.- 2.1 Duration of coronary occlusion.- 2.2 Status of collateral circulation.- 2.3 Infarct size/'risk area' ration.- 3. A historical perspective to the measurement of 'risk area'.- 4. Role of MCE is the assessment of 'risk area'.- 4.1 Validation of the technique.- 4.2 'positive' versus 'negative' RA.- 4.3 Relationship of RA to extent of abnormal wall motion.- 4.4 Time-dependent changes in RA.- 4.5 Relationship of RA to infarct size.- 4.6 Relationship between RA and hemodynamic parameters.- 4.7 Relationship of RA and LV systolic function.- 5. The lateral borders of the 'risk area'.- 6. Summary.- Acknowledgements.- References.- 7. Quantitation of regional myocardial perfusion using myocardial contrast two-dimensional echocardiography.- 1. Coronary blood flow versus nutrient (myocardial) blood flow.- 2. Large microbubbles and blood flow.- 3. Small microbubbles and blood flow.- 3.1 Method of analysis.- 3.2 Subselective injection into a coronary artery.- 3.3 Selective injection into the left main coronary artery.- 3.4 Assessment of coronary blood flow reserve.- 3.5 Intraoperative assessment of blood flow.- 3.6 What is the best parameter to measure?.- 3.7 Epicardial versus endocardial flow.- 3.8 Assessment of myocardial flow following a venous injection of contrast.- 4. Summary.- Acknowledgements.- References.- 8. Coronary venous myocardial contrast echocardiography.- 1. The rational of retrograde infusions.- 2. Experimental retrograde MC-2DE models.- 3. Experimental observations.- 4. Suitability and limitations of the retrograde MC-2DE method.- 5. Future retrograde MC-2DE potentials and prospects 148 References.- 9. Assessment of contrast decay half life by MC-2DE: Preliminary clinical experience.- 1. Introduction.- 2. Echocontrast agents.- 3. Registration of myocardial contrast echocardiograms.- 4. Analysis of MC-2DE images.- 5. T50 values derived from MC-2DE.- 6. Safety of MC-2DE.- 7. Reproducibility of T50 measurements.- 8. Clinical applications of T50.- 9. Limitations and future prospects.- References.- 10. Clinical trials with a new myocardial contrast agents.- 1. Introduction.- 2. Qualitative contrast echocardiography in humans.- 3. Quantitative contrast echocardiography in humans.- 4. Future directions.- Acknowledgements.- References.- 11. Clinical evaluation of severity of coronary arterial stenosis by contrast echomyocardiography.- 1. Introduction.- 2. Method.- 3. Results.- 4. Discussion.- 4.1 Myocardial echo enhancement.- 4.2 Contrast agents.- 4.3 Quantitative analysis.- 4.4 Problems in clinical applications.- 5. Summary.- References.- 12. Clinical applications of myocardial contrast echocardiography.- 1. Introduction.- 2. Myocardial contrast echocardiography in relation to regional myocardial perfusion.- 3. Contrast echocardiography during coronary angioplasty.- 4. Assessment of coronary vascular reserve by myocardial contrast echocardiography.- 5. Safety of myocardial contrast echocardiography in humans.- 6. Limitations.- 7. Perspectives and future directions.- Acknowledgement.- References.- 13. The issue of an intravenous MC-2DE methodology. A typical early study.- Section One: Recapitulation of problems and potentials by the volume-editor Samuel Meerbaum.- Section Two: Evaluation of myocardial echo enhancement by intra venous contrast echomyography in dogs.- 2.1 Introduction.- 2.2 Method.- 2.2.1 Experimental preparation.- 2.2.2 Echocardiographic examination.- 2.2.3 Experimental protocol.- 2.3 Results.- 2.3.1 Variation of the echo intensity of the normal myocardium.- 2.3.2 Effects of ether on the enhancement of myocardial echo.- 2.3.3 Effects of hydrogen peroxide on myocardial echo enhancement.- 2.3.4 Echo enhancement of regional myocardium after ligation of the left anterior descending coronary artery.- 2.4 Discussion.- Section Three: Present developments, progress and prospects by the volume-editor Samuel Meerbaum.- 3.1 Introduction.- 3.2 Optimal MC-2DE agents.- 3.3 Ultrasound system improvement for intravenous MC-2DE.- References.- 14. Current perspective and future prospects.- 1. General MC-2DE capabilities and limitations.- 2. Quantitation of myocardial perfusion.- 3. Efforts aimed at clinical application.- 4. Future prospects.