UTILITA DELL'ECOCONTRASTOGRAFIA NELLA DIAGNOSI DELLE MALFORMAZIONI CARDIACHE CONGENITE IN ETA NEONATALE

Peripheral injection of different solutions (indocyanine green, saline, glucose or blood) with simultaneous M-mode echocardiography has been reported as a useful tool for identifying single cardiac structures and detecting intra-or extracardiac shunts. We describe three cases of neonates with serious congenital heart diseases (pulmonary atresia with right ventricle of normal size; transposition of the great vessels with mitral atresia; tricuspidal atresia), in which the use of echocontrastographic technique was helpful in making an exact diagnosis. In these conditions diagnosis was not possible by the use of routine echocardiography. After injections of 10% glucose (1 ml/Kg) and of patient's blood through peripheral or umbilical vein contrast echoes were recorded simultaneously from the suprasternal notch or from the precordium. In the first case, a right-to-left atrial shunt and extremely difficult evacuation of the right ventricle (pulmonary atresia) were shown. In the second case, opacifications of the aorta and of the right pulmonary artery were diagnostic for the origin of both great vessels from the same ventricular cavity and/or for the transposition of the great vessels. In the third case, right-to-left atrial shunt was detected and the absence of contrast echoes in the right ventricle indicated tricuspid atresia. We confirm the importance of contrast echocardiography in the diagnosis of congenital heart disease, especially in the neonate in which the avoidance of invasive methods is of great value.