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(Circulation. 2003;107:2390.)
© 2003 American Heart Association, Inc.

Images in Cardiovascular Medicine

Real-Time Perfusion Echocardiography of an Intracardiac Mass

Petr Tousek, MD; Marek Orban, MD; Albert Schömig, MD; Christian Firschke, MD

From Deutsches Herzzentrum, München, Germany.

Correspondence to Priv.-Doz. Dr. med. Christian Firschke, Deutsches Herzzentrum München, Lazarettstrasse 36, D-80636 München, Germany. E-mail cfirschke{at}t-online.de

A 59-year-old woman was referred to our hospital for evaluation of chest pain and dyspnea. On transthoracic echocardiography, a left atrial mass suggestive of myxoma was detected (Figure 1A). To evaluate the vascularization of the left atrial mass, venous infusion (1 mL/min) of a third-generation echocardiographic contrast agent (Sono Vue, Bracco, Italy) was subsequently combined with a new contrast-specific imaging technique ("power modulation imaging," Phillips Medical Systems, Eindhoven, the Netherlands). With conventional diagnostic ultrasound, gas-filled microbubbles, the main components of echocardiographic contrast agents, are destroyed by high acoustic power (mechanical index usually >0.8) and tissue perfusion cannot be continuously imaged. Power modulation imaging, on the other hand, allows for marked reduction of transmission power (mechanical index 0.1 in the present study), resulting in tissue microbubble concentrations unequivocally above the detection threshold of the imaging system. Therefore, tissue perfusion can be continuously visualized with this technique.

View larger version (68K): [in this window] [in a new window]   Figure 1. A, Conventional 2-dimensional echocardiography demonstrating left atrial mass (asterisk) prolapsing through the mitral valve during diastole. B, Venous infusion of the echocardiographic contrast agent at 1 mL/min and visualization with power modulation imaging. The contrast agent has arrived in the left ventricular cavity (encoded in hues of yellow and red) but not yet in the myocardium or the left atrial mass (no color-coding in these tissues). C (a few frames later than B), Demonstration of perfusion not only of the myocardium but also of the left atrial mass indicated by opacification of both tissues, which, as distinct from panel B, are now encoded in hues of yellow and red.

Figure 1B depicts the appearance of the contrast agent in the cavity of the left ventricle after initiation of the contrast infusion. A few frames later (Figure 1C), the left ventricular myocardium and the left atrial mass were opacified at the same time. Preoperative coronary angiography demonstrated normal coronary arteries and vascular supply of the left atrial mass originating from the right coronary artery (Figure 2). The patient underwent surgery, and histopathologic evaluation confirmed the initial suspicion of myxoma.

View larger version (104K): [in this window] [in a new window]   Figure 2. Angiographic demonstration of vascular supply of the left atrial mass from the right coronary artery (arrows).

Acknowledgments

Dr Tousek was supported by a grant from the German Cardiac Society, Düsseldorf, Germany. Dr Orban was supported by a grant from the Czech Cardiac Society, Brno, Czech Republic.

Footnotes

The editor of Images in Cardiovascular Medicine is Hugh A. McAllister, Jr, MD, Chief, Department of Pathology, St Luke’s Episcopal Hospital and Texas Heart Institute, and Clinical Professor of Pathology, University of Texas Medical School and Baylor College of Medicine.

Circulation encourages readers to submit cardiovascular images to the Circulation Editorial Office, St Luke’s Episcopal Hospital/Texas Heart Institute, 6720 Bertner Ave, MC1-267, Houston, TX 77030.

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