Contrast ventriculography

Contrast ventriculography (VG) is one of the important catheterization angiographic methods. Ventriculography is the contrasting of the ventricle of the heart with recording of the image on film or another recording device (video film, computer hard or CD-disk). It is widely used to determine the X-ray anatomy and contractility of the ventricles in patients with heart defects, ischemic heart disease, cardiomyopathy.

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Left ventriculography

Contrast of the left ventricle (LV) (left ventriculography) provides information about its volume, general and regional contractility, the state of the mitral (regurgitation) valve, the presence and localization of a septal defect, changes in the shape and configuration of the cavity in case of aneurysm, ischemia or myocardial hypertrophy.

Right ventriculography

Contrast of the right ventricle (RV) (right ventriculography) also allows to evaluate the volumetric parameters of this chamber of the heart, general and local contractility in patients with heart defects, and recently it is often done in coronary heart disease and cardiomyopathy, since in these diseases the RV is often involved in the pathological process. Right ventricular infarctions are often combined with inferior myocardial infarction of the LV, which worsens the prognosis and course of this disease. There are nosological forms with predominant damage to the RV: arrhythmogenic dysplasia of the RV, right-sided dilatational cardiomyopathy, obstruction of the outflow tract of the RV in hypertrophic cardiomyopathy, etc.

How is ventriculography performed?

To obtain an adequate image of the ventricle, approximately 40 ml of RVC is required, injected with an automatic syringe-injector through a VG catheter, the tip of which is located in the ventricular cavity, at an injection rate of approximately 10-16 ml/s.

The volume of the RVF and the rate of its administration depend on the size (internal lumen) of the catheter and ventricular cavity, and the state of hemodynamics before the IH. If the LV EDP is > 27-30 mm Hg, IH should be avoided until it decreases (nitroglycerin, diuretics) to avoid pulmonary edema due to the additional hypervolemic load associated with the intake of high-molecular RVF. If necessary, two-projection ventriculography is performed in the right anterior oblique projection at an angle of 30° and the left oblique projection at 45-60° to assess all ventricular segments. Most often, single-projection ventriculography is performed in the right anterior oblique projection. In this case, the LV is visible along its long axis and the anterior basal, anterolateral segments, apex, inferior, posterobasal segments, and the mitral valve area can be assessed. If it is necessary to study the interventricular septum (for example, in patients with post-infarction anterior LV aneurysm), a left oblique projection is additionally performed.

Regional ventricular contractility is determined quantitatively by computer image processing based on the percentage shortening of radii drawn from the ventricle center, or qualitatively by frame-by-frame viewing as a disturbance of wall motion from systole to diastole. Hypokinesia is diagnosed with a decrease in the amplitude of motion, akinesia with no wall motion from systole to diastole, and dyskinesia with a segment bulging during systole beyond the diastole contours.

Thus, with post-infarction focal changes in the LV, a- and dyskinesia (aneurysm) are often determined; with ischemia of any segment - hypokinesia; with dilated cardiomyopathy - expansion of the cavity and diffuse hypokinesia of all segments; with hypertrophic cardiomyopathy, the contours of the LV cavity often acquire one or another configuration (in the form of a peak with a pointed apex in the apical form, in the form of a banana or ballerina's foot in subaortic stenosis, in the form of an hourglass in midventricular hypertrophic cardiomyopathy).

At the end of the last century, with the introduction of digital angiography with computer image processing, background mask subtraction and resulting enhancement of the final image, it became possible to administer 2 times smaller amounts of RCA with better patient tolerance and smaller changes in hemodynamics. It became acceptable to visualize the interventricular septum with a single administration of 20 ml of RCA into the right atrium.

Complications of ventriculography

• Heart rhythm disturbances - ventricular extrasystoles, single and grouped, are often encountered during ventriculography; they are caused by the tip of the catheter touching the inner wall of the ventricle or by the jet of RCA when it is inserted into the cavity. Preventive measures: careful placement of the catheter in the ventricular cavity, reduction of the rate of RCA insertion, sometimes it is necessary to administer antiarrhythmic drugs, perform defibrillation;
• "endocardial spot" symptom - when a single-lumen catheter is used for ventriculography and its tip rests against the wall, it is possible for the contrast to get under the endocardium. Since the "pigtail" type catheter with additional lateral holes began to be used, this complication is practically uncommon;
• embolism by a thrombus or air from the catheter, as well as a dislocated thrombus fragment in intraventricular mural thrombosis. To avoid this, carefully check the automatic injector-catheter connection for air bubbles. If an intraventricular thrombus is present according to echocardiography data, try not to touch it with the catheter or refuse to perform ventriculography;
• reactions associated with the action of RCA - a feeling of heat, nausea, rarely vomiting. Usually these phenomena quickly pass, and with the use of non-ionic RCA in recent decades, they have become rare. In case of an allergic reaction, antihistamines (diphenhydramine, suprastin, etc.), glucocorticosteroids, adrenaline are administered, and infusion therapy is performed.

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