Cardiac ventriculography is a diagnostic test, i.e., used to define the anatomy and function of the ventricles (left and right) and related structures.
Left Ventriculography
Left ventriculography is helpful in the assessment of the following parameters:
1) Segmental and global LV function
2) Mitral valve regurgitation
3) Ventricular septal defect–their presence, location and severity
4) Hypertrophic cardiomyopathy
Right Ventriculography
Rarely performed in adults. Useful in assessment of:
1) Segmental and global RV function
2) Assessment of RV in Congenital heart disease.
Choice of Catheters for Ventriculography
1) Pigtail Catheter: This catheter developed by Judkins has end hole and side holes. The end hole permits insertion of the catheter over a J-tipped guide wire so that it can be safely advanced into the ventricle. The loop keeps the end hole away from direct contact with the endocardium. The multiple side holes permit simultaneous exit routes for the contrast and help to stabilize the catheter and prevent recoil.
2) Sones Catheter
3) NIH and Eppendorf Catheters
4) Lehman Catheter
Injection Site
This is best achieved by injecting directly into the ventricular chamber. Midcavitary position of the catheter ensures that there is no ventricular ectopy; sufficient contrast is delivered to chamber and apex, valve function is not interfered with and there is no endocardial staining.
Injection Rate and Volume
A pressure injector or flow injector can be used to deliver contrast material into the ventricle.Most laboratories follow a pressure cut-off of 1000 psi. For the pigtail and most of the other catheters, an injection rate of 10 to16 ml/sec and a volume of 30 to 55 ml is desirable. Care should be taken to avoid air embolism.
Filming Projection and Technique
Biplane ventriculography is preferred over single plane ventriculography because it gives more information without additional risk to the patient. Whether it is biplane or single plane ventriculography, one should use a view that gives maximum information of the area of interest with minimal overlapping of adjacent structures. For biplane ventriculography, the preferred view is 30 ° right anterior oblique (RAO) and 60 ° left anterior oblique (LAO). For single plane it is 30 °RAO and 45 ° to 60 ° LAO views. For routine ventriculography, cineangiography at 30 frames/sec using a 9 inch field of view is recommended.
Analysis of the Ventriculogram
The Ventriculogram should be assessed for:
— global and regional systolic ventricular function.
— degree of valvular regurgitation.
— any other specific area of interest.
Complications of Ventriculography
Complications of Injection
1) Arrhythmias
2) Endocardial staining
3) Fascicular block
4) Embolism–Air or thrombus
Alternatives to Contrast Ventriculography
1) Echocardiography
2) Magnetic Resonance Imaging
3) Electromechanical mapping
Left Ventriculography
Left ventriculography is helpful in the assessment of the following parameters:
1) Segmental and global LV function
2) Mitral valve regurgitation
3) Ventricular septal defect–their presence, location and severity
4) Hypertrophic cardiomyopathy
Right Ventriculography
Rarely performed in adults. Useful in assessment of:
1) Segmental and global RV function
2) Assessment of RV in Congenital heart disease.
Choice of Catheters for Ventriculography
1) Pigtail Catheter: This catheter developed by Judkins has end hole and side holes. The end hole permits insertion of the catheter over a J-tipped guide wire so that it can be safely advanced into the ventricle. The loop keeps the end hole away from direct contact with the endocardium. The multiple side holes permit simultaneous exit routes for the contrast and help to stabilize the catheter and prevent recoil.
2) Sones Catheter
3) NIH and Eppendorf Catheters
4) Lehman Catheter
Injection Site
This is best achieved by injecting directly into the ventricular chamber. Midcavitary position of the catheter ensures that there is no ventricular ectopy; sufficient contrast is delivered to chamber and apex, valve function is not interfered with and there is no endocardial staining.
Injection Rate and Volume
A pressure injector or flow injector can be used to deliver contrast material into the ventricle.Most laboratories follow a pressure cut-off of 1000 psi. For the pigtail and most of the other catheters, an injection rate of 10 to16 ml/sec and a volume of 30 to 55 ml is desirable. Care should be taken to avoid air embolism.
Filming Projection and Technique
Biplane ventriculography is preferred over single plane ventriculography because it gives more information without additional risk to the patient. Whether it is biplane or single plane ventriculography, one should use a view that gives maximum information of the area of interest with minimal overlapping of adjacent structures. For biplane ventriculography, the preferred view is 30 ° right anterior oblique (RAO) and 60 ° left anterior oblique (LAO). For single plane it is 30 °RAO and 45 ° to 60 ° LAO views. For routine ventriculography, cineangiography at 30 frames/sec using a 9 inch field of view is recommended.
Analysis of the Ventriculogram
The Ventriculogram should be assessed for:
— global and regional systolic ventricular function.
— degree of valvular regurgitation.
— any other specific area of interest.
Complications of Ventriculography
Complications of Injection
1) Arrhythmias
2) Endocardial staining
3) Fascicular block
4) Embolism–Air or thrombus
Alternatives to Contrast Ventriculography
1) Echocardiography
2) Magnetic Resonance Imaging
3) Electromechanical mapping
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