Myocardial Drainage via Thebesian Veins: Demonstration by Contrast Enhanced Color Doppler

In order to increase the sensitivity of color Doppler imaging, 15 patients with ischemic heart disease were evaluated before and after intravenous injections of 10 mL SH U 508 (200 mg/mL). This new contrast agent contains stabilized microbubbles capable of transpulmonary passage and it is expected to enhance left ventricular flow display. After injection of SH U508, left ventricular filling and outflow were imaged in brighter colors and on wider areas than in the baseline study: the display of filling (percentageof thecross-sectionalarea) increasedfrom 30%± 14% (mean value ± standard deviation) to 54%± 16%, P < 0.01, the display of outflow increased from 27%± 13% to45%± 15%, P < 0.01, respectively. In addition, color Doppler imaging with SH U 508 demonstrated single or multiple mosaic flow patterns, which were different from the flow areas in the inflow and outflow tracts. The additional flow areas were found during systole and diastole and originated from the apical myocardium in most of the patients. Further clinical and angiographic investigation revealed no evidence of coronary artery fistulas to the left ventricle. Color Doppler after intravenous injection of SH U 508 provides improved display of left ventricular filling and outflow. In addition, flow patterns are displayed that probably represent myocardial drainage by Thebesian veins. (ECHOCARDIOGRAPHY, Volume 8, September 1991)