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Ann Thorac Surg 2003;75:1542-1548
© 2003 The Society of Thoracic Surgeons

Original article: cardiovascular

Contrast echocardiography: potential for the in-vivo study of pediatric myocardial preservation

Meredith L.K. Sheil, MBBS, FRACPa,b*, Timothy B. Cartmill, MBBS, FRACSa,b, Graham R. Nunn, MBBS, FRACSa, Gary F. Sholler, MBBS, FRACPa, Olli T. Raitakari, MD, PhDd, David S. Celermajer, PhD, FRACPa,c,d

a Adolph Basser Cardiac Institute, The Children’s Hospital, Westmead, NSW, Australia
b department of Paediatrics and Child Health, University of Sydney, Sydney, Australia,
c department of Medicine, University of Sydney, Sydney, Australia
d Royal Prince Alfred Hospital, Sydney, Australia

Accepted for publication November 22, 2002.

* Address reprint requests to Dr Sheil, Adolph Basser Cardiac Institute, The Children’s Hospital Westmead, Locked Bag 4001, Westmead, NSW, Australia 2145
e-mail: meredits{at}chw.edu.au

BACKGROUND: Myocardial contrast echocardiography (MCE) has been used successfully during adult cardiac surgery to image myocardial perfusion. Recently it has been suggested this technique is capable of detecting microvascular injury and inflammation because sonicated albumin microbubbles adhere to activated neutrophils and, in the presence of denuded or inflamed endothelium, they persist within the microvasculature rather than passing unimpeded, which results in profound slowing of their transit rates. The technique has not previously been used during congenital heart surgery; however significant potential is suggested in this setting in which myocardial inflammation may contribute to postoperative myocardial dysfunction, a leading cause of morbidity and mortality. We have performed a preliminary study to assess the safety and feasibility of MCE in the pediatric intraoperative environment and to examine myocardial transit rates.

METHODS: Sonicated albumin microbubbles were injected with cardioplegia during bypass in 16 children (aged 3 weeks to 8.5 years). Images were collected using transesophageal echocardiography. Complications, postbypass electrocardiographic, echocardiographic, and outcome data were recorded. Myocardial transit rates were calculated using videointensity analysis, assessed for reproducibility and correlated with demographic and intraoperative variables and postoperative outcome.

RESULTS: The technique was performed safely, with good reproducibility. Myocardial persistence of microbubbles, which occurred in 6 patients, was associated with crystalloid cardioplegia, prolonged preischemic bypass (r = 0.72, p = 0.004), or ischemic time (r = 0.69, p = 0.002).

CONCLUSIONS: Intraoperative MCE shows potential as an in vivo technique for the study of pediatric myocardial preservation.






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