Contrast Echocardiography and Clinical Safety

The use of contrast media provides a greater diagnostic yield for echocardiographic techniques.1 In combination with the possibility of performing myocardial perfusion studies, its use can be generalized in stress echocardiography. It therefore leads us to question the safety they afford concerning adverse reactions, an issue that has recently led to the temporary withdrawal from the market of one of these products used in echocardiography. We present the case of a 42 year old man with a history of an acute anterior myocardial infarction 4 months previously, and single vessel coronary disease (100% middle anterior descending), with a normal ejection fraction and apical akinesia. He was referred to the echocardiograph laboratory for measurement of apical myocardial viability by means of stress echocardiography with dobutamine, prior to attempting revascularization. When the patient was clinically and hemodynamically stable, the study was started according to the usual protocol; contrast material was not considered necessary at this point. On reaching a dobutamine infusion dose of 10 μg/kg/min, a heart rate of 105 bpm, and a blood pressure of 140/70 mm Hg, a bolus dose of 1.5 mL of Sonovue® was given, maintaining a mechanical index of 0.3. The patient immediately developed sudden sweating, rubefaction and bradycardia, followed by severe hypotension and cardiorespiratory arrest. Advanced cardiopulmonary Letters to Editor