Bidimensional real time echocardiological visualization of a ventricular right to left shunt following peripheral vein injection

Contrast techniques were used in the echocardiological evaluation of a 28-year-old patient with congenital cyanotic heart disease; catheterization showed an association of an atrial septum defect, a ventricular septum defect, and a patent ductus arteriosus, with equalization of pulmonary artery and systemic pressures. Glucose 5% in water, injected as a 10-ml bolus into an antecubital vein, constituted an adequate echogenic contrast solution. The heart was examined with both a single-crystal transducer (echoes recorded in M mode) and with a 51-elements dynamically focused multiscan system (echoes recorded on video-tape). Contrast echocardiology showed that right-to-left shunting occurred at the level of the ventricular septum defect and was not significant at the atrial level.