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Cardiology
Pulmonary Angiography
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
9 sections · 88 slides
Overview
- Scope of this topic
- Current uses of catheter pulmonary angiography
Anatomy of the pulmonary circulation
- Course of the main pulmonary artery
- Branching of the right pulmonary artery
- Branching of the left pulmonary artery
- Segmental branching of both pulmonary arteries
- Pulmonary venous drainage
Pulmonary embolism
- Burden and mode of death in pulmonary embolism
- Symptoms of acute pulmonary embolism
- Clinical signs of right ventricular dysfunction
- Clinical probability scoring
- Electrocardiographic findings in acute pulmonary embolism
- D-dimer and arterial blood gas analysis
- Initial imaging in suspected pulmonary embolism
- Interpreting low and intermediate probability lung scans
- Diagnostic accuracy of multidetector CT
- Magnetic resonance imaging for pulmonary embolism
- Venous ultrasonography and contrast venography
- Transthoracic echocardiography for risk stratification
- Diagnostic sequence in suspected pulmonary embolism
- Predictors of a positive pulmonary angiogram
- Yield of angiography by number of predictors present
- Timing of angiography after the acute episode
Other indications
- Role of angiography in chronic thromboembolic pulmonary hypertension
- Angiographic appearances of chronic thromboemboli
- Treatment pathway in chronic thromboembolic disease
- Persistent pulmonary hypertension after thromboembolectomy
- Angiographic features of primary pulmonary hypertension
- Vasodilator challenge at catheterisation
- Pulmonary arteriovenous malformations
- Pulmonary artery stenosis after congenital heart surgery
- Pulmonary artery aneurysms
- Partial anomalous pulmonary venous return
Equipment and procedure
- Choice of venous access site
- Upper limb and jugular access options
- Confirming iliac or caval thrombosis during the procedure
- Choice of contrast agent
- Determinants of contrast injection rate
- Right ventricular end-diastolic pressure and contrast safety
- Digital subtraction angiography: advantages
- Digital subtraction angiography: limitations
- Angiographic projections
- Monitoring during the procedure
- Sequence of the procedure
- Transfilter angiography through an inferior vena cava filter
- Catheter and sheath sizes
- Pigtail catheters for pulmonary angiography
- Balloon-tipped angiographic catheters
- The Grollman pulmonary artery catheter
- Catheter selection in an enlarged right heart
- Catheters used in pulmonary angiography
- Injection rates and volumes
Interpreting the angiogram
- Right lung angiogram through a pigtail catheter
- Selective and superselective injections
- Angiographic findings in pulmonary embolism
- Angiographic correlates of haemodynamic compromise
- Massive right pulmonary artery embolism before and after thrombectomy
- Occluded right pulmonary artery before intervention
- Restored right pulmonary artery flow after thrombectomy
- Limitations of interpretation
Complications and contraindications
- Major complications of pulmonary angiography
- Risk in pulmonary hypertension and the PIOPED experience
- Minor complications
- Cardiac tamponade and catheter choice
- Contraindications and high-risk groups
- Preparation of the contrast-allergic patient
Catheter-directed therapy for acute pulmonary embolism
- Risk categories and mortality in acute pulmonary embolism
- Definitions of massive and submassive pulmonary embolism
- Systemic thrombolysis versus catheter-based intervention
- Catheter-directed intervention techniques
- Catheter Directed Intervention Techniques and Devices
- Choosing between catheter-directed options
Summary
- Key points on the diagnostic role
- Key points on safety and therapy
- References
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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