The first edition of this definitive text ran to 24 chapters. The second edition, reflecting the explosive growth of interest in echo-enhancement, contains 44. The first section deals with some of the most important emerging issues and technologies and covers harmonic imaging, the use of echo-enhancers to provide quantitative information, and the application of enhanced power Doppler to tissue imaging. The second, on contrast echocardiography, explores the use of echo-enhancement during transesophageal imaging. One chapter describes the use of contrast-enhancement transesophageal imaging to determine coronary flow reserve and another gives a detailed account of the application of the technique to the evaluation of left ventricular function. Other authors describe the intraoperative use of contrast echocardiography and discuss the potential of myocardial contrast echocardiography to replace thallium scintigraphy. Another chapter covers the emerging technique of transient response imaging and its role in the assessment of myocardial perfusion, and two chapters are devoted to three-dimensional contrast echocardiographic assessment of myocardial perfusion. Use of echo-enhancement in the evaluation of peripheral circulation is discussed in chapters on carotid and peripheral arterial flow imaging and others that describe renal and hepatic vascular imaging. The newer applications of echo-enhancement outside the cardiovascular system are described in three chapters devoted to the visualization of tumour vasculature. The final chapters look to the future and cover the imaging of intramyocardial vasculature, the development of site-specific agents and the emergence of the new acoustically active agents.

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.

The first edition of this definitive text ran to 24 chapters. The second edition, reflecting the explosive growth of interest in echo-enhancement, contains 44. The first section deals with some of the most important emerging issues and technologies and covers harmonic imaging, the use of echo-enhancers to provide quantitative information, and the application of enhanced power Doppler to tissue imaging. The second, on contrast echocardiography, explores the use of echo-enhancement during transesophageal imaging. One chapter describes the use of contrast-enhancement transesophageal imaging to determine coronary flow reserve and another gives a detailed account of the application of the technique to the evaluation of left ventricular function. Other authors describe the intraoperative use of contrast echocardiography and discuss the potential of myocardial contrast echocardiography to replace thallium scintigraphy. Another chapter covers the emerging technique of transient response imaging and its role in the assessment of myocardial perfusion, and two chapters are devoted to three-dimensional contrast echocardiographic assessment of myocardial perfusion. Use of echo-enhancement in the evaluation of peripheral circulation is discussed in chapters on carotid and peripheral arterial flow imaging and others that describe renal and hepatic vascular imaging. The newer applications of echo-enhancement outside the cardiovascular system are described in three chapters devoted to the visualization of tumour vasculature. The final chapters look to the future and cover the imaging of intramyocardial vasculature, the development of site-specific agents and the emergence of the new acoustically active agents.