Pulmonary wedge injections yielding left-sided echocardiographic contrast

Ultrasound contrast on the left side of the heart without the need for left heart catheterisation was achieved by hand injections of 8 to 10 ml 5% dextrose solution through a catheter in the pulmonary wedge position. Injections were performed in 18 patients undergoing routine cardiac catheterisation and M-mode or two-dimensional echocardiography was used. An adequate wedge position was attained in 17 of the 18 patients. 9 had injections through Cournand catheters, 3 through Swan-Ganz catheters, and 5 through both. In 11 of these 17 patients left atrial or left ventricular echocardiographic contrast was seen immediately after wedge injection. 2 patients showed diminished or absent contrast on later injections from the same position. Better results were obtained with the Cournand catheter (11/15 positive) than with the Swan-Ganz (1/8 positive) catheter. Pulmonary artery injections proximal to the wedge position did not cause left-sided contrast. No complications were observed. The safety of this method remains to be determined.