Contrast echocardiography using gas-filled bubbles have been used for 40 years 1, although the clinical use of agents capable of pulmonary transit for left heart opacification started about 15 years ago. Microbubble solutions made by a variety of manufacturers have now been approved for clinical use in North America, Europe, Australia and some Asian countries. Indeed, Definity (a lipid shell filled with perfluorocarbon) has been administered to ~2 million patients since 2001 2. Why then has there been a cluster of recent papers about the safety of contrast agents?3-6
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