Transesophageal echocardiogram demonstrating papillary muscle rupture following inferior myocardial infarction.
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Contrast echocardiography during coronary arteriography in humans: perfusion and anatomic studies.
Feinstein SB, Lang RM, Dick C, Neumann A, Al-Sadir J, Chua KG, Carroll J, Feldman T, Borow KM.
Section of Cardiology, University of Chicago Medical Center, Illinois 60637.
In humans, the physiologic relation between myocardial blood flow and epicardial coronary artery anatomy remains poorly defined. With the recent development of sonicated microbubble contrast agents, it is now possible to use contrast echocardiography to assess myocardial perfusion and to correlate blood flow with angiographically identified coronary artery anatomy. The purpose of the current study was to determine myocardial perfusion patterns in patients without significant coronary artery disease. The results may be used as a reference to analyze myocardial blood flow in patients with coronary artery disease. Sonicated meglumine sodium diatrizoate solution (Renografin-76), which contains microbubbles measuring 4.5 +/- 2.8 micrograms in diameter by laser analysis, was used as the echocardiographic contrast agent during elective coronary arterriography in 14 patients without significant coronary artery disease. Patients received intracoronary injections of 1.5 to 2 ml of sonicated Renografin-76 without complications. Perfusion characteristics were studied by visual assessment of the two-dimensional echocardiographic images obtained after individual injections. In patients found to be free of significant coronary artery disease by arteriography, the left coronary system always supplied the anteroseptal, anterior, anterolateral and posterior regions of the left ventricle at the mid-papillary, cross-sectional level. The right coronary artery system perfused the inferior and inferoseptal regions in 89% of the patients identified with a right dominant system. The anterolateral papillary muscle was perfused from the left coronary system in all cases. The posteromedial papillary muscle was perfused from the left coronary system in 58% of the patients and from the right system in 42% of the patients.
Am J Cardiol. 1996 Oct 15;78(8):955-8.
Left ventricular papillary muscle perfusion assessed with myocardial contrast echocardiography.
Lim YJ, Masuyama T, Nanto S, Mishima M, Kodama K, Hori M.
Cardiology Division, Kawachi General Hospital, Higashi Osaka.
This myocardial contrast echocardiographic study shows that left ventricular posteromedial papillary muscle is supplied by either the right or left coronary artery in most subjects, but may be supplied by both coronary arteries. The posteromedial papillary muscle and its adjacent area may be supplied by a different coronary artery.
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