Masking and Unmasking of Isolated Noncompaction of the Left Ventricle With Real-Time Contrast Echocardiography
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Noncompaction of the left ventricle is characterized by thin, compacted subepicardial myocardium and a thicker, noncompacted subendocardial layer.1 Because the intertrabecular cavity recesses in noncompaction may not be adequately visualized on transthoracic echocardiography, ultrasound-enhancing agents have been used to delineate these recesses within the noncompacted layer.2 The American Society of Echocardiography has recommended the use of harmonic imaging with a very low mechanical index (MI) to reduce microbubble destruction and improve left ventricular and intertrabecular opacification.2 We present a case of left ventricular noncompaction where very low MI imaging actually masked detection of the noncompacted layer. A method is proposed to preferentially destroy microbubbles in the trabecular myocardium and improve delineation and quantification of the noncompacted layer.
A 47-year-old male with symptoms of worsening orthopnea was referred for …