CONTRAST ECHOCARDIOGRAPHY AND REAL-TIME THREE-DIMENSIONAL ECHOCARDIOGRAPHY FOR THE DIAGNOSIS OF VENTRICULAR NONCOMPACTION

Background. The diagnosis depends on the identification of a 2-layered structure of the left ventricular wall with prominent trabeculations, and deep intertrabecular recesses filled with blood from the LV cavity visualized by color Doppler. However, such a diagnosis may be missed even by experienced echocardiographers, due to non-optimal imaging of the apical et lateral myocardium, and low blood flow inside the recesses. Methods. We evaluated the usefulness of contrast echocardiography and 3-D echocardiography in 10 patients with suspected LV noncompaction. The diagnosis was considered as definite with 2-D echo and color Doppler in 5 patients, and uncertain in 5. We used a Sonos 7500 ultrasound system. Contrast study was made using 1 ml bolus of SonoVue. Real-time 3-D transthoracic images were obtained using a 4MHz 4x matrix probe. Results. In all the patients, contrast study allowed better characterization of the apical and lateral segments. In the 5 patients with a definite diagnosis of noncompaction, contrast improved the identification of intertrabeculation recesses and the measurement of the thickness of the noncompacted layer. In the 5 patients with an uncertain diagnosis, noncompaction could be confirmed in 4 and rejected in 1. 3-D study provided additional information by showing a typical spongy appearance with, in 3 cases, small mobile thrombi inside the recesses. Conclusion. Second-generation contrast agents, and real-time 3-D echo are useful for the diagnosis of noncompacted myocardium.
Support: IGA MZ ČR NR 7983-3, MSM 0021622402.