Left ventricular angiography is used to assess global and regional left ventricular function and anatomy. It involves inserting a catheter into the left ventricle and injecting contrast dye to visualize the ventricle on x-ray imaging. The procedure provides key information on mitral valve function, ventricular shape and wall motion abnormalities, and congenital defects like VSD. LV volumes and ejection fraction are calculated from the images to quantify function. Regional wall motion is graded and correlated to coronary artery territories. Characteristic appearances are seen in conditions like cardiomyopathy, mitral regurgitation, and septal defects. Potential complications include arrhythmias and endocardial injury.
2. TARGETS
ο½ INTRODUCTION
ο½ INDICATIONS
ο½ EQUIPMENT
ο½ PROCEDURE
ο½ COMPLICATIONS
ο½ NORMAL LV ANGIOGRAM
ο½ CALCULATION OF LV FUNCTION
ο½ MITRAL REGURGITATION
ο½ VSD
ο½ SPOTTERS
3. INTRODUCTION
ο½ In 1929 Werner Forssman, inserted a urologic
catheter into his right atrium from a left antecubital
vein cut down he had performed on himself using a
mirror.
ο½ Retrograde left heart catheterization was first done
by Zimmerman,Limon Lason & Bouchard in 1950βs
(Nobel prize in 1956).
ο½ Used to be the only method available for assessing
LV segmental dysfunction.
4. INDICATIONS
ο½ Define the anatomy and function of left ventricle.
ο½ Global and segmental LV function-qualitative and
quantitative
ο½ Mitral valvular regurgitation
ο½ Congenital heart disease βVSD
ο½ Cardiomyopathy
ο½ LV non compaction.
5. EQUIPMENT
ο½ 1.INJECTION CATHETERS
-large amount of contrast in short
period of time.
-6F/7F/8F catheter with multiple side
holes.
-angled(145-155) pigtail catheters
-straight tip ventriculographic
catheters- sones catheter,
NIH,eppendorf catheters,Lehmann
catheter.
-Balloon tip ventriculographic
catheters- Berman
6. Equipment..
2.Power injectors β flow
injectors (Medrad)
- volume and rate of
delivery can be selected
- maximal pressure limit
of 1000psi
- can be synchronised
with R wave
- hand injection should
be avoided.
7. EQUIPMENTβ¦
ο½ 3.Biplane ventriculography
better than single plane
ventriculography.
-more information at no
additional risk.
-single injection of contrast.
ο½ Disadvantages-
higher cost
additional time
Reduced quality of
cineangiographic images
8. PROCEDURE
ο½ Approach to LVβ
Retro aortic ,injection directly into the
ventricles
Anterograde/trans septal approach
Apical left ventricular puncture
ο½ Optimal catheter position βmidcavitary
adequate delivery to body and apex
will not interfere with MV function
less endocardial staining and ventricular
ectopy
9. PROCEDURE..
ο½ Cine left ventriculography with
contrast vol β 30-36ml
rate β 10-12ml/sec(pig tail)
- 7-10 ml/sec(sones)
ο½ Older imaging systems required image acquisition at
deep inspiration.
ο½ Newer imaging systems permits imaging during
normal quite breathing.
10. FILMING PROJECTION AND TECHNIQUE
ο½ Cine left ventriculography
β 15-30 frames/sec
ο½ Typically 30 deg RAO and
60 deg LAO views are
obtained
ο½ 30 deg RAO
eliminates overlap of LV
and the vertebral column
anterior apical inferior
segmental wall motion
mitral valve profile ideal
for assessment of MR
11. FILMING PROJECTION..
ο½ 60 deg LAO
- assess ventricular
septal integrity and
motion
- lateral and posterior
segmental function
- aortic valvular anatomy
-15-30 deg cranial
angulation for profiling
entire IVS
16. LV FUNCTION ASSESSMENT
ο½ Cineventriculography
was the first method
introduced in the routine
practice to determine
the LVEF.
ο½ The area-length
technique is the most
widely used method to
quantify the left
ventricular diastolic and
systolic volumes.
17. LV FUNCTION ASSESSMENT
ο½ MEASURE
Ventricular dimension
Area
Wall thickness
ο½ DERIVE
Chamber volume
Ejection Fraction
LV mass
LV wall stress
18. STEPS IN LV VOLUME CALCULATION
ο½ 1.Tracing LV outline or
silhoutte
ο½ 2.Marking aortic valve
border
ο½ 3.Calculation of LV
volume by computer
based algorithms
ο½ 4.Magnification
correction
ο½ 5.Applying Regression
Equation
19. ο½ Angiographic stroke
volume,SV = EDV β
ESV
ο½ Ejection fraction,EF =
(EDV β ESV) / EDV
ο½ LV wall thickness,h is
measured at end
diastole at LV free wall
2/3 distance from aortic
valve to apex in RAO
ο½ LV Mass = Vc+w - VC
CALCULATION OF LV MASSCALCULATION OF LV EF
22. REGIONAL LV DYSFUNCTION
ο½ Regional wall motion can be graded qualitatively as
normal, hypokinetic, akinetic, dyskinetic,or
hyperkinetic.
ο½ The analyses of the RAO and LAO projections as
the following segments:
24. MITRAL REGURGITATION
ο½ Diagnosis and assessment of severity of MR
DEGREE VENTRICULOGRAPHIC CRITERIA
1+ Faint opacification of the left atrium with clearing of
contrast during each beat
2+ Opacification of the atrium that does not clear but is
not as dense as the left ventricle
3+ Opacification of the atrium with the same density as
the ventricle
4+ Immediate, dense opacification of the atrium with
filling of the pulmonary veins
27. HYPERTROPHIC CARDIOMYOPATHIES
ο½ In HCM, cavity obliteration
is commonly seen together
with small ventricular end-
systolic volumes .
ο½ Systolic anterior motion of
the mitral valve may result
in severe degrees of mitral
regurgitation.
ο½ The ventriculogram in the
apical variant typically
appears with a βspadeβ-
shaped contour.
28. TAKO TSUBO CARDIOMYOPATHY
ο½ Diffuse akinesis of LV
apex with preserved
basal contractilty.
ο½ Characteristically
resemble the shape of a
japanese octopus
trap(tako-tsubo)
29. VENTRICULAR SEPTAL DEFECT
ο½ A standard view in the
evaluation of patients
with ASDs or muscular
VSDs is the
hepatoclavicular view
at 30β¦ to 45β¦ LAO and
30β¦ to 45β¦ cranial