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Cardiology
Ventriculography and Aortography
Built from Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
What’s inside
16 sections · 143 slides
Overview
- Scope of this presentation
Left ventriculography: role and indications
- Decline of routine left ventriculography
- Indications for left ventriculography
- Left ventricular measurement on a right anterior oblique ventriculogram
- SCAI consensus guidance on optimal use
- Patients in whom ventriculography poses significant risk
Equipment for ventriculography
- The angled pigtail catheter
- Pigtail design and alternative catheters
- The Langston dual-lumen catheter
- Catheter diameter and injection rate
- Guidewires for crossing the aortic valve
Anatomic considerations and fundamentals
- Variables to consider when imaging a cardiac cavity
- Catheter position for standard ventriculography
- Anatomic Areas of Interest, Catheter Position, and Angulation Views
- The 10% contrast principle
- Worked example: normal ventricle
- Worked example: severe aortic insufficiency
- Planimetry and the ellipsoid assumption
- Deriving ventricular volume from the projections
- Correcting for radiographic magnification
- Single-plane method and edge detection
Crossing the aortic valve
- Crossing a non-stenotic aortic valve
- Troubleshooting a failed crossing
- Crossing a stenotic aortic valve
- Catheter selection in aortic stenosis
- Prosthetic valves and ventriculography
Ventriculography technique and injector settings
- Standard ventriculographic projections
- Left ventricular wall segments in the oblique projections
- Contrast volume for the left ventricle
- Precautions in elevated LV end-diastolic pressure
- Dilated left ventricular chamber in diastole
- Positioning the pigtail within the ventricle
- Manual injection in the unstable patient
- Power injector settings for ventriculography
- System integrity and air embolism prevention
- Comparison of pigtail catheter shapes
- Determinants of ventriculogram quality
- Optimising image quality in practice
Quantifying ventricular function
- Wall-motion abnormalities
- Angled pigtail ventriculogram in diastole and systole
- ACC and AHA reporting standards for LV function
- Ten-segment division of the left ventricle
- Reporting workflow for a ventriculogram
- Ventriculogram in left ventricular hypertrophy
Quantifying mitral regurgitation
- Chamber compliance and acuity of regurgitation
- Why angiographic grading is semiquantitative
- Technique for grading mitral regurgitation
- Angiographic Assessment of Mitral Regurgitation
- Severe mitral regurgitation on ventriculography
- Regurgitant fraction and regurgitant volume
- Effective forward flow and timing of repair
- Regurgitant Fraction Estimation in Mitral Regurgitation
Use, evidence and limitations
- Variation in use of left ventriculography
- Institutional culture drives variation
- Ventriculography and acute kidney injury
- Deep neural network estimation of LVEF from angiograms
- Comparison with echocardiography and thermodilution
- Three-dimensional echocardiography and other comparators
- Prognostic value and comparability of LVEF
Contraindications and complications
- Relative contraindications
- Absolute contraindications to left ventriculography
- Ventriculography in cardiogenic shock and severe CAD
- Complications of ventriculography
- Mechanisms of injury during ventriculography
- Cerebral microemboli during left heart catheterization
- Massive air embolisation
Left atrial and right ventricular angiography
- Left atrial angiography
- Technique for left atrial angiography
- Geometry of the right ventricle
- Indications for right ventriculography
- Technique for right ventriculography
- Right ventricular outflow tract with a large pulmonary artery aneurysm
- Ventriculography: summary of its remaining role
Aortography: role and indications
- Definition and scope of aortography
- Information gained by catheter position
- Dacron graft repair with distal aortic dilatation
- Embryology of the aortic arch system
- Anatomic Result of Aortic Arch Regression and Fusion during Embryogenesis
- Aortic arch branch variants
- Occluded aberrant right subclavian artery on digital subtraction angiography
- Abdominal aortic branch anatomy and variants
- Collateral pathways in aortic occlusive disease
- Bilateral renal artery stenosis with severe distal aortic disease
Aortography: equipment and technique
- Age-related changes in the aorta
- Access route selection in the diseased aorta
- Equipment for contrast aortography
- Wires and catheters for aortography
- Selecting the arterial access site
- Navigating complex aortic anatomy
- Ascending aortic aneurysm with an arch dissection flap
- Indications for aortography
- Ascending aortic aneurysm extending into the arch
- Digital subtraction angiography of the aorta
- Closure of a graft perforation under angiographic guidance
- Interrupted descending aorta and coarctation with collaterals
Ascending aortography and injector settings
- Projections for ascending aortography
- Catheter placement for ascending aortography
- Catheter size for aortography
- Modulating the injection kick
- Injection settings for thoracic aortography
- Air embolism prevention in aortography
Aortic insufficiency and abdominal aortography
- Technique for quantifying aortic insufficiency
- Bicuspid aortic valve with severe aortic insufficiency
- Angiographic Assessment of Aortic Insufficiency
- Dilated sinuses of Valsalva with aortic regurgitation
- Severe aortic root dilatation after valve replacement and graft repair
- Transcatheter aortic valve deployment on aortography
- Abdominal aortography technique
- Vertebral levels of the abdominal aortic branches
- Abdominal aortic branch origins
- Takayasu arteritis with renal artery stenosis and aortic narrowing
Limitations, complications and conclusions
- Limitations of aortography
- Carbon dioxide angiography
- Noninvasive comparators for aortic imaging
- Mural findings on computed tomographic angiography
- Technical hazards in the severely diseased aorta
- Iatrogenic aortic dissection
- Embolic and systemic complications
- Consequences of a false-lumen catheter
- Aortography: conclusions
- Key points to carry away
- References
- References (continued)
- References (continued)
- References (continued)
- References (continued)
- Cardiovascular Catheterization and Intervention: A Textbook of Coronary, Peripheral, and Structural Heart Disease
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