The opacification of the left ventricle by echo cardiographic contrast agents (echoventriculography) represents an alternative to cineventriculography, as determinations of left ventricular volume and ejection fraction are accurate and highly reproducible, when methods like color superposition and statist- ical imaging techniques are used in order to improve the outlining of the cavity and endocardial border. Detection of perfusion defects is possible [40]. The enhancement of myocardial contrast during the perfusion phase after injection into the left ventricle or the aorta further improves the endo- cardial border delineation. For practical purposes, the direct injection of echocardiographic contrast is inferior to the indirect opacification after per- ipheral venous injection which can be achieved with sonicated albumin, Albunex(R), SH U 508 A, HOE 155. These drugs are presently under clinical investigation. In up to 90% of the patients, left heart opacification is possible, yielding 30% intensity of the right ventricle.
When these drugs are available, sophisticated computed methodologies have to be included in the echocardio- graphic machines in order to improve the determination of the left ventricular volume and ejection fraction [44]. In the future, cineventriculography will be rarely performed as echoventriculograms already show left ventricular contraction. This will possibly result in reduced side effects and costs. REFERENCES 1. Gramiak R, Shah PM, Kramer DH. Ultrasound cardiography: Contrast studies in anatomy and function. Radiology 1969; 939. 2. Kronik G, Hutterer B, Mosslacher H. Diagnose atrialer Links-rechts-Shunts mit Hilfe der zweidimensionalen Kontrastechokardiographie. Z Kardiol 1981;70:138-45.