shu-508 and Graft-Occlusion--Vascular

a) To study the capacity of the technique of high-frequency color Doppler to detect flow signal of left internal mammary artery grafts; b) to assess the usefulness of an echo-enhancer agent to facilitate the detection of the signal, and c) to evaluate the patency of the graft according to its pulsed Doppler velocity profile pattern.. 39 consecutive patients were studied. A Hewlett-Packard 5500 echocardiograph was used, with a high-frequency probe (S12) applied at the high left parasternal border. When a graft signal was not elicited after a predetermined 5-minute check period, an intravenous dose of 4 g of Levovist (Schering España) at 400 mg/ml was administrated. According to previous studies, a pulsed Doppler flow profile with a predominantly diastolic pattern was considered a normal graft patency, while a systolic one was deemed as abnormal.. Graft flow was identified by color Doppler in 33/39 patients (85%). The additional use of an echo-enhancer in 6 patients with no detected signal increased this proportion to 38/39 (97%). Normal flow patterns were seen in 34/38 (89%). Among the four patients with abnormal pattern, 1 case of early myocardial infarction was observed, while angiographic studies showed distal occlusion of the graft in 1 or the presence of competitive flow in 2 patients.. The high-frequency color Doppler technique allows the detection of a flow signal from internal mammary artery grafts in most patients. The administration of an echo-enhancer agent is useful in those with non detectable signals. An abnormal pulsed Doppler velocity pattern indicates graft malfunction.

Topics: Blood Flow Velocity; Contrast Media; Echocardiography, Doppler, Color; Graft Occlusion, Vascular; Humans; Internal Mammary-Coronary Artery Anastomosis; Magnetic Resonance Imaging; Mammary Arteries; Polysaccharides; Prospective Studies; Vascular Patency

In-stent hemodynamics were studied by transesophageal echocardiography (TEE) in a group of 54 patients after left main coronary artery stenting, during a 6-month follow-up. TEE was performed within 24 hours after stenting and at 1- and 3-month follow-up. Pulsed wave and color Doppler signals were enhanced by IV administration of Levovist.. Angiographic immediate success was obtained in all patients. No in-hospital death occurred. Ten patients (18.4%) complained of recurrent angina at the follow-up of 4.8 ± 1.2 months. Both TEE and coronary angiography confirmed in-stent restenosis in all. Thirty-nine patients (68.5%) remained symptoms free. Mean late loss in these patients was 0.69 ± 0.20 mm. A linear significant positive relation between mean late loss values and diastolic coronary velocity (r: 0.89, P < 0.001) was found. After 3- and 6-month follow-up, PDV showed a significant increase in comparison with basal values (0.7 ± 0.3 and 0.6 ± 0.26 vs. 0.32 ± 0.2 cm/sec, P < 0.01). All patients with restenosis showed a significant increase of diastolic coronary velocity in comparison with basal values (2.89 ± 0.25 cm/sec, P < 0.001).. TEE can predict the development of in-stent intimal hyperplasia in patients with unprotected left main coronary artery stenting.

Topics: Contrast Media; Coronary Circulation; Coronary Restenosis; Echocardiography, Transesophageal; Female; Graft Occlusion, Vascular; Humans; Male; Polysaccharides; Reproducibility of Results; Sensitivity and Specificity; Stents; Treatment Outcome

Stress echocardiography has recently gained increased importance as a method for assessment of left ventricular function. However, suboptimal image quality in some patients may limit use of this technique. In the present study, 10 patients with moderate image quality in the resting echocardiograms (apical 4-chamberview) were reinvestigated after administration of the intravenous transpulmonary saccharide-based left heart contrast agent SHU 508 A. Duration of contrast enhancement in the left ventricle determined by visual assessment was 135 s (SEE +/- 39) at rest and 112 s (+/- 24) during maximum exercise. On a scale ranging from O (no contrast) to 4 (excessively strong contrast) enhancement averaged 2.5 at rest and during exercise. The left ventricle was divided into three segments (septum, apex, lateral wall) and delineation of the endocardial border was assessed. Detection of the border improved significantly after contrast administration, especially at the lateral wall. Despite better visual assessment of the endocardial border, there was no improvement in automatic or semi-automatic contour recognition. No clinically significant side-effects were observed. Three patients reported a sensation of warmth at the injection site. In conclusion, intravenous administration of SHU 508 A improves visual detection of the left ventricular endocardial border in patients with suboptimal image quality and helps to achieve acceptable diagnostic accuracy with stress echocardiography in these patients.

Topics: Aged; Angioplasty, Balloon, Coronary; Cardiac Output; Cardiomyopathies; Contrast Media; Coronary Artery Bypass; Coronary Disease; Echocardiography; Exercise Test; Female; Graft Occlusion, Vascular; Hemodynamics; Humans; Male; Middle Aged; Polysaccharides; Veins; Ventricular Function, Left