Contrast cine left ventriculography: comparison of two pigtail catheter shapes and analysis of factors determining the final quality.
Ventricular arrhythmias or inadequate opacification of the ventricular cavity during contrast-cine left ventriculography frequently interfere with evaluation of regional wall motion, ejection fraction or mitral regurgitation. In this prospective, randomized study traditional (straight) pigtail catheter was compared with a new, large loop pigtail catheter (both 6 French, large lumen) in terms of the quality of the cine left ventriculograms. Straight (Group I) and curved pigtail (Group II) groups were further subdivided randomly into a preset (13 cc per second for 3 seconds with a pressure rise time of 0.5 seconds) injection rate (Group IA, n = 46, and Group IIA, n = 48) or operator definded injection rate (Group IB, n = 49, and Group IIB, n = 45) subgroups. The ventricular tachycardia and couplets occurred at similar frequency among the groups. The curved pigtail subgroups showed significantly more frequent catheter induced mitral regurgitation. However, the opacification and overall quality of the left ventriculograms were distributed similarly between the groups. Because the catheter type and injection protocol did not affect the left ventriculogram quality in our study, variables determining opacification and overall quality rating are analyzed in the overall group of 190 patients. Left ventricular opacification was excellent in 72, acceptable in 108 and marginal in 10 patients. The patients with marginal opacification were significantly heavier (P = .004) with larger left ventricular enddiastolic volumes (P = .019), and smaller amount of contrast volume per enddiastolic volume (P = .005) and kilogram body weight (P = .003). The overall quality of left ventriculograms were excellent in 38, acceptable in 133, and marginal in 19 patients. The patients with excellent left ventriculograms were significantly younger (P = .019) and slightly less heavy (P = 0.09). Significantly more female patients were also in this group (P = .036). Ventricular tachycardia was the most common cause of unsatisfactory left ventriculograms. In the RAO view, deeper (more apical) placement of the catheter was associated with higher incidence of ventricular tachycardia (53%). The most "silent" area was the posterobasal area. In conclusion, the perfect left ventriculogram remains to be an elusive goal in routine clinical practice. When using 6F highflow pigtail catheters and nonionic contrast agents, more basal catheter position and higher contrast volume increase the quality of the left ventriculograms.
Deligonul
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U
Cardiology Section, University of Nebraska Medical Center, Omaha 68198-2265, USA.
Jones
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S
Shurmur
S
S
Oskarsson
H
H
D000328:Adult; D000368:Aged; D006328:Cardiac Catheterization / Q000295:instrumentation*; D002932:Cineangiography / Q000295:instrumentation*; D003287:Contrast Media / Q000008:administration & dosage*; D004867:Equipment Design; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging*; D009200:Myocardial Contraction / Q000502:physiology; D011446:Prospective Studies; D011856:Radiographic Image Enhancement / Q000295:instrumentation; D013318:Stroke Volume / Q000502:physiology*; D017180:Tachycardia, Ventricular / Q000000981:diagnostic imaging*; D016277:Ventricular Function, Left / Q000502:physiology*
D003287:Contrast Media