Contrast Ventriculography

Contrast ventriculography (VG) is one of the important catheterization angiography techniques. Ventriculography is the contrast of the ventricle of the heart with the recording of an image on a film or other recording device (videotape, computer hard or CD-ROM). It is widely used to determine roentgenotomy and ventricular contractility in patients with heart defects, coronary artery disease, cardiomyopathy.

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Left ventriculography

Left ventricular (LV) contrast (left ventriculography) gives information on its volume, general and regional contractility, the state of mitral (regurgitation) of the valve, the presence and localization of the septal defect, changes in the shape and configuration of the cavity in aneurysm, ischemia or hypertrophy of the myocardium.

Right ventriculography

Contrasting the right ventricle (right ventriculography) allows also to estimate the volumetric parameters of this heart chamber, general and local contractility in patients with heart disease, and recently it is often done in IHD and cardiomyopathies, since in these diseases the prostate is often involved in the pathological process. Right ventricular infarctions are often combined with lower myocardial infarction of the LV, which worsens the prognosis and course of this disease. There are nosological forms with the predominant lesion of the prostate: arrhythmogenic dysplasia of the prostate, right-sided dilative cardiomyopathy, obstruction of the outgoing tract of the prostate in hypertrophic cardiomyopathy, etc.

How is ventriculography performed?

In order to obtain an adequate image of the ventricle, about 40 ml of RVC, administered by an automatic syringe-injector along the VH-catheter, whose tip is located in the ventricular cavity, is required, at a rate of about 10-16 ml / s.

The volume of RVR and the rate of its administration depend on the size (internal lumen) of the catheter and the cavity of the ventricle, the state of hemodynamics before the HH. If the LVC> 27-30 mm Hg. (nitroglycerin, diuretics) should be avoided in order to avoid pulmonary edema due to the hypervolemic extra load associated with the receipt of a high molecular weight RV. If necessary, two projection ventriculography is performed in the right anterior oblique projection at an angle of 30 ° and a left oblique projection of 45-60 ° to assess all segments of the ventricle. Most often do single-projection ventriculography in the right anterior oblique projection. In this case, the LV is visible along its long axis and the anterior basal, anterolateral segments, apex, lower, posterior basal segments and mitral valve region can be assessed. If it is required to study the interventricular septum (for example, in patients with postinfarction anterior left aneurysm), a left oblique projection is additionally performed.

The regional contractility of the ventricles is quantified by computer processing of the image according to the percentage shortening of the radii drawn from the center of the ventricle, or qualitatively in frame-by-frame viewing as a violation of wall movement from systole to diastole. With a decrease in the amplitude of motion, hypokinesia is diagnosed, in the absence of movement of the wall from systole to diastole - akinesia, when the segment swells into the systole behind the contours of the diastole - dyskinesia.

For example, in postinfarction focal changes of the left ventricle, a- and dyskinesia (aneurysm) is often determined, hypoconasia is hyphemic in ischemia, dilated cardiomyopathy - widening of the cavity and diffuse hypokinesia of all segments, with hypertrophic cardiomyopathy, the contours of the LV cavity often acquire this or that configuration (in the form of a peak with a pointed tip with apical form, a banana or a ballerina foot with subaortal stenosis, in the form of an hourglass with medium ventricular hypertrophic cardiomyopathy).

At the end of the last century, with the introduction of digital (digital) angiography with computer image processing, the subtraction of the background mask and the resulting resulting image enhancement, it was possible to introduce 2 times smaller amounts of RVW with better patient tolerance and less changes in hemodynamics. It became permissible to visualize the interventricular septum with a single injection of 20 ml of RKV into the cavity of the right atrium.

Complications of ventriculography

• heart rhythm disturbances - ventricular extrasystoles single and group often occur in ventriculography, they are caused to touch the tip of the catheter of the inner wall of the ventricle or jet of RVB when it is inserted into the cavity. Preventive measures: careful placement of the catheter in the cavity of the ventricle, a decrease in the rate of administration of RVC, sometimes it is necessary to inject antiarrhythmic drugs, to do defibrillation;
• a symptom of the "endocardial stain" - when a single-lumen catheter is used for ventriculography and its tip rests against the wall, it is possible to hit the contrast under the endocardium. Since the "Piggy tail catheter" type with lateral additional apertures has been used, complications are almost not encountered;
• embolism with a blood clot or air from a catheter, as well as a dislocated thrombus fragment with intragastrial parietal thrombosis. To avoid this, carefully check the connection of the automatic injector catheter to the air bubbles. If there is an intraventricular thrombus according to EchoCG data, you should try not to touch it with a catheter or refuse ventriculography;
• reactions associated with the action of RVC, - a feeling of heat, nausea, rarely vomiting. Usually, these phenomena quickly pass, and with the use of non-ionic RVBs in recent decades, they have rarely been encountered. In the case of an allergic reaction, antihistamines (dimedrol, suprastia, etc.), glucocorticosteroids, adrenaline, and infusion therapy are administered.

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