What an incredible time for cardiovascular imaging. Image guidance has become a universal standard of care that will only continue to increase in importance and ingenuity.
In this issue of CASE, we definitely see the impact of recognizing life-threatening situations. The right heart is the recipient of deep-seated invaders, such as those resulting from deep vein thrombosis, metastases, other masses, and even the complications of a Marjolin's ulcer. Echocardiography often unveils the first clue of an emergency. Early recognition is imperative to prevent death. Surgery, embolectomy, anticoagulation, and chemotherapy have been the usual recommended treatments.
Today, we have the honor of sharing the innovative use of microbubbles. One such case demonstrates thrombus dissolution using high-mechanical index impulses from transthoracic echo during intravenous infusion of ultrasound contrast. Can you believe I said “transthoracic” and “thrombus dissolution?!” Yes, it is true. This is a fascinating concept that may lead to new state-of-the-art treatment options.
We also feature two cases that associate cardiac microbubbles with cirrhosis of the liver. Bowel gas released into the portal vein, made its way to the inferior vena cava, and eventually the left heart. The authors refer to this phenomenon as “cardiac flatulence.” I never thought of that one before: left heart microbubbles as a sign of a decomposing liver.
While we are at it, let's talk about harpooning the mitral valve back together… what?!
We routinely discover multiple septums and dangerous passageways. Echo saves lives through diagnostic surveillance, image guidance, and now therapeutic intervention.
Hearts will never be practical until they can be made unbreakable.
-The Wizard of Oz
Game On!