M6 Cardiac_Ventriculography *

What is the goal of catheter selection in ventriculography? often what french size?

To achieve adequate opacification of the chamber with 6 Fr. - 8 Fr. catheters.

what do you see in this vgram

thrombus

What are the 3 types of catheters used in ventriculography?

Pigtail Catheters,

Straight Tip Catheters,

Balloon Tip Catheters.

function of the sideholes on the pigtail catheter

They have a pigtail curl and multiple side holes to prevent the contrast jet from damaging the endocardium.

What types of catheters are Sones and Gensini?

Straight tip catheters widely used in early cardiac catheterization.

What is a balloon tip catheter used for?

Imaging ventricles, pulmonary arteries, and pulmonary veins anatomy.

dependent on the placement of side holes whether distal or prox depends on if its intended for wedge or ventricle

What are the projections used in left ventriculography?

30° RAO, Anterior, Apical, Inferior, 60° LAO, Septal, Lateral, Posterior.

What is the optimal catheter position in ventriculography?

Midcavity for adequate delivery to the body and apex of the chamber.

What is considered a normal ejection fraction (EF)?

50% - 70%.

What is the EF of mild hypokinesis?

Mildly reduced wall motion, with EF ranging from 35% - 49%.

What is the typical cause of endocardial staining?

It is caused by improper catheter position.

What injection rate is typically used for a pigtail catheter?

10 - 12 ml/second.

Lack of wall motion; the wall doesn't contract.

Define akinesia as it relates to ventricular analysis.

Abnormal wall motion, where the wall moves in the opposite direction during contraction.

What is dyskinetic wall motion?

What can cause PVCs during ventriculography?

Improper catheter position.

What is the Ejection Fraction classification for severe hypokinesis?

Less than 20%.

What should be monitored when using Gensini and Sones catheters?

Catheter position and rate of contrast injection to avoid endocardial staining. due to straight tip

What is the purpose of balloon tip catheters?

To prevent jets from side holes from damaging the endocardium.

Mitral Valve Regurgitation (MVR) assessment graded from what to what

graded from 1 - 4

1 being best

4 being severe

What is the risk associated with high-pressure contrast injection?

It may cause endocardial staining.

What is the technique (type of catheters) for imaging in the right heart system?

Using balloon tip catheters for easier advancement.

______________ ______ occurs when there is improper catheter positioning during ventriculography, leading to the contrast media causing discoloration of the heart

endocardial staining

Catheters used for coronary angiography from the radial approach are generically called __________ catheters because they can engage both the _____ and the _____ coroanry ostia

universal catheters

engage both left and right

left ventriculography best view for

anterior

apical

inferior
sides of the heart is

30 RAO

in L ventriculography

best view for

septal

lateral

posterior

sides of the heart is

60 LAO

in LVG 60 LAO is best view for what sides of the heart

3x

septal

lateral

posterior

in LVG 30 RAO

is best view for what sides of the heart

3x

anterior

apical

inferior

for RVG

what is the best view to see the RVOT & central pulmonary arteries

AP CRA

For RVG in AP CRA

you can see what sides of the hearts

RVOT (infundibulum)

CENTRAL PA

what is the orientation on the left and right

L LAO

R RAO

label the heart surface in this LAO angiographic image

1. basal/ posterior

2. lateral

3. apical

   1. septal

label the heart surface in this RAO angiographic image

1. anterior basal

2. anterior

3. apical

4. inferior

5. inferior basal

review this image

review this

image to assess cardiac function and identify any abnormalities in the ventricles.

review this

found in HOCM. is a sign of left ventricular outflow tract obstruction. It's characterized by a drop in arterial pressure after a premature heartbeat. 

Brockenbrough phenomenon

Paradoxical Drop in Arterial Pulse Pressure:

• Instead of generating a strong post-PVC pulse (which happens in normal hearts), the LVOT obstruction blocks blood flow, leading to:

  • Higher LV pressure (because blood is retained due to the obstruction).

  • Lower aortic pressure (because less blood is ejected).

• This results in a decreased pulse pressure (lower SBP) after the PVC.

more volume leads to greater obstruction due to the hypertrophied septum and systolic anterior motion (SAM) of the mitral valve

what cardiomyopathy

apical HCM

projection?

RAO

WALL MOTION ASSESSMENT

ESTIMATED EF

NORMAL

55-60% EF

• projection

• Wall motion assessment

• Estimated ejection fraction

• Any valvular disease visualized

• Wall motion assessment: Severe global hypokinesis

• Estimated ejection fraction: ~20%

• Any valvular disease visualized: none

• projection

• Wall motion assessment

• Estimated ejection fraction

• Any valvular disease visualized

• Projection (RAO/LAO): RAO

• Wall motion assessment: Severe global hypokinesis

• Estimated ejection fraction: ~20%

• Any valvular disease visualized: none

• Projection (RAO/LAO)

• Wall motion assessment

• Estimated ejection fraction

• Any valvular disease visualized

• Projection (RAO/LAO): RAO

• Wall motion assessment: Takotsubo (anterior, apical and inferior akinesis)

• Estimated ejection fraction: ~30%

• Any valvular disease visualized: none

• IABP present

Ventriculogram: Poor EF Secondary to Massive M.I. 42 second loop.

Review the image carefully and give the abnormality seen in the image. 

4+ MR

what is the rating of mitral regurg

4+ M.R.

Review the image carefully and give the abnormality seen in the image. 

LV ANEURYSM