The significant milestones, which have been responsible for the development of myocardial contrast echocardiography (MCE), have been discussed in this review. The development of stable microbubbles behaving as erythrocyte tracers, capable of withstanding transpulmonary passage, was the first major technological breakthrough. Consistent visualization of these microbubbles in the myocardium remained elusive until the advent of harmonic imaging systems and the realization that lower mechanical index imaging coupled with intermittent ultrasound triggered to end-systole resulted in less microbubble destruction. The ability to accurately quantify myocardial blood flow (MBF), using MCE, has ushered in renewed optimism for the continued growth of this technique in the field of clinical myocardial perfusion imaging.