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P5 - Angiocardiography

This document discusses various imaging techniques for examining the heart, including angiocardiography. Angiocardiography involves inserting a catheter into the heart and injecting contrast dye to visualize the heart structures. It provides information on pressures, blood flow, and abnormalities. The document describes the equipment, contrast agents, techniques, and optimal views used for angiocardiography examinations.

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Kudzy Matadi
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503 views19 pages

P5 - Angiocardiography

This document discusses various imaging techniques for examining the heart, including angiocardiography. Angiocardiography involves inserting a catheter into the heart and injecting contrast dye to visualize the heart structures. It provides information on pressures, blood flow, and abnormalities. The document describes the equipment, contrast agents, techniques, and optimal views used for angiocardiography examinations.

Uploaded by

Kudzy Matadi
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPT, PDF, TXT or read online on Scribd
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THE HEART

Imaging of the heart


• Chest radiography
• Fluoroscopy
• Angiocardiography
• Echocardiography, including the
transoesophageal technique
• Radionuclide imaging
• - ventriculography
• - myocardial perfusion imaging
• - acute myocardial infarction imaging
• CT
• MRI
Angiocardiography
• Usually performed simultaneously with
cardiac catheterization
• pressures and oximetry are measured in the
cardiac chambers and vessels that are under
investigations.
• The right heart, left heart and great vessels
are examined together or alone, depending on
the clinical indication.
Indications

• Congenital heart disease and anomalies of


the great vessels
• Valve disease
• Myocardial disease and ventricular
function.
Contrast medium

• LOCM 370
• 1ml per kg at 18 -20 mls per sec for adults
• 1.5mls per sec for 2 sec below one year
• 1.2mls per sec for 2 sec for 2 to 4 years
• 1ml per sec for over year olds for 2 sec
Equipment
• Biplane fluoroscopy and cine radiography,
• preferably digital
• and preferably with C-arms to facilitate axial
projections
• Pressure recording device
• ECG monitor
• Blood oxygen analyser
• Catheter
continued

• Pressure recording device


• ECG monitor
• Blood oxygen analyser
• Catheter
• For pressure measurements and blood
sampling: - Cournand
• For angiocardiography: NIH or pigtail
cournand
NIH
Pig tail
Technique
• Right-sided cardiac structures and pulmonary
arteries are examined by introducing a catheter
into a peripheral vein.
• In babies the femoral vein may be the only vein
large enough to take the catheter.
• If an atrial septal defect is suspected, the femoral
vein approach offers the best chance of passing
the catheter into the left atrium through the defect.
continued

• In adults the right antecubital or basilic vein


may be used.
• The cephalic vein should not be used
because it can be difficult to pass the
catheter past the site where the vein pierces
the clavipectoral fascia to join the axillary
vein.
• The catheter, or introducer, is introduced
using the Seldinger technique.
• (The NIH catheter must be introduced via
an introducer as there is no end hole for a
guide-wire.)
• In children it is usually possible to examine
the left heart and occasionally the aorta by
manipulating a venous catheter through a
patent foramen ovale.
• In adults the aorta and left ventricle are
studied via a catheter passed retrogradely
fromthe femoral artery.
• The catheter is manipulated into the
appropriate positions for recording
pressures and sampling blood for oxygen
saturation.
• Following this, angiography is performed.
Films

• The recording of cardiac images is now


most commonlyperformed using digital
subtraction angiography at 30 frames per s.
• Angled views which place the pathological
lesion at rightangles to the X-ray beam
increase diagnostic accuracy in
angiocardiography.
• The first principle of axial cineangiography
is axial alignment of the heart, i.e. Aligning
the X-ray beam perpendicular to the long
axis of the heart
• The second principle involves rotation of
the direction of the X-ray beam so as to
profile those areas of heart under
examination.
Films continued
• For modern equipment with movable C-arms it
is possible to achieve correct positioning by
moving the equipment alone without
disturbing the patient.
• 40"O caudal-cranial (sitting up) view.
• 40° cranial/40° LAO (hepatoclavicular or
four-chamber)
• Long axial 20° RAO (long axial oblique) view.

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