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[Digital subtraction angiocardiography--an alternative to traditional angiocardiography?].

Intravenous (i.v.) digital angiography has been extensively and successfully used for studying peripheral arterial vessels. Its application in the heart now results in high resolution images of the cardiac chambers. Accuracy and reproducibility of left ventricular volume determination equal that of conventional cineangiocardiography. Thus, left ventricular regional and global function can be analyzed quantitatively at rest and during exercise with higher simplicity and lower risk even on an outpatient basis by i.v. digital subtraction angiocardiography. To date, however, the coronary artery system cannot be visualized by digital image processing using i.v. injection of contrast medium, i.e., in patients win whom the coronary arteries have to be examined, selective arteriography for the future, too, will be combined with direct left ventricular angiocardiography. Regarding clinical experience till now, digital subtraction angiocardiography must be characterized as a complementary rater than an alternative method to conventional cineangiocardiography.

Angiocardiography↗

Comparison of left ventricular ejection fraction assessed by radionuclide angiocardiography, echocardiography and contrast angiocardiography.

The left ventricular ejection fraction (EF) obtained by first pass radionuclide angiocardiography was compared with that determined by contrast angiocardiography in 49 patients. In 35 of the patients a comparison with the EF obtained by M-mode echocardiography was also made. The EF echo was determined in two ways, from the standard cube formula and the regression equation suggested by Teichholz for left ventricular volume calculations. The latter formula gave an average EF closer to the average EF obtained by isotope technique and cineangiography and was therefore used in the comparison study. Measurements of EF by isotope technique and echocardiography correlated well (r = 0.78). The correlation between these two noninvasive methods for EF determination and their cineangiographic counterpart was almost identical (r = 0.72--0.74).

Adult↗

[Digital subtraction angiocardiography: accuracy of measuring left ventricular wall thickness and wall volume during intravenous contrast media injection].

A comparison of left ventricular wall thickness and wall volume determined by intravenous digital subtraction angiocardiography and by conventional left ventricular angiocardiography was performed by linear regression analysis: wall thickness: WDDSA = 0.90 X WDLV , Syx = +/- 0.16 cm, r = 0.74; wall volume: WVOLDSA = 0.87 X WVOLLV , Syx = +/- 48 ml, r = 0.85. Compared to the deviation and scatter of corresponding data measured from two consecutive beats in conventional left ventricular angiocardiographies , the error of determination of wall thickness and wall volume, determined by intravenous digital subtraction angiocardiography, is more pronounced. The regression analysis of wall volumes under rest and bicycle exercise evaluated by digital subtraction angiocardiography revealed a similar inaccuracy ( Syx = +/- 46 ml). This is due to faults in recognition of the inner and outer contours of left ventricular wall. Our results show that measurements of left ventricular wall thickness and wall volumes by means of intravenous digital subtraction angiocardiography can only be performed with greater deviations compared to conventional left ventricular angiocardiograms.

Angiocardiography↗

Right ventricular imaging with digital subtraction angiocardiography using intraventricular contrast injection.

Angiocardiography is of considerable value in the dimensional analysis of the right ventricular (RV) cavity, but conventional angiocardiography requires large amounts of contrast medium. In this study digital subtraction angiocardiography was applied to biplane RV projections of 25 children with congenital heart disease after direct injection of a small dose of contrast medium. Volume measurements were compared with those obtained by conventional angiocardiography. The amount of contrast medium required was reduced to 30%, flow rate to 57% and ventricular ectopic activity to 60% of that used in conventional angiocardiography, and the degree of radiation exposure was reduced considerably. There was a good correlation for end-diastolic (r = 0.996) and end-systolic volume (r = 0.990) determined with both techniques. Digital subtraction angiography after selective RV injection allows accurate volume measurements of the right ventricle in children with congenital heart disease. The main benefits of this method are reduction of the amount of contrast medium, flow rate during injection, radiation and ventricular ectopic activity.

Adolescent↗

Diagnosis of isolated dextrocardia using angiocardiography or surgery.

BACKGROUND: Isolated dextrocardia is a rare phenomenon and usually associated with multiple cardiac anomalies. This study was to evaluate the accuracy of diagnosis of isolated dextrocardia by using angiocardiography and to compare it with the results of surgery. METHODS: The clinical data of 27 cases of congenital isolated dextrocardia were collected to understand the diagnostic approaches to the major cardiac anomalies. All cases underwent angiocardiography followed by palliative or curative surgery. The diagnosis was compared by angiocardiography relying on segmental analysis with the pathological features observed in surgery. RESULTS: The results of angiocardiography of 22 patients were the same as the pathological features observed during surgery, including one case with congenital left ventricular diverticulum was inadvertently omitted in angiocardiograhy. There were significantly dissimilar diagnoses between angiocardiograhy and post-operation in 5 patients, including anatomical corrected transposition of great arteries misinterpreted as corrected transposition of the great arteries in 1, complete transposition of great arteries misinterpreted as corrected transposition of the great arteries in 1, single ventricle misinterpreted as double-outlet right ventricle in 1, and anatomical double-outlet left ventricle misinterpreted as corrected transposition of the great arteries in 2. Misdiagnostic rate of angiocardiograhy was almost 20%. CONCLUSIONS: Angiocardiography is of great significance in the diagnosis and classification of isolated dextrocardia. However, because of the intricacy of cardiac anomalies of isolated dextrocardia, atrial angiography and double oblique projection are needed to improve the accuracy of diagnosis to support surgical treatments.

Adolescent↗

[Angiocardiography in the diagnosis of congenital bulboventricular heart defects. Anatomopathological and angiocardiographic correlations].

Current surgical methods enable radical treatment of the most bulboventricular malformations (syn. conotruncal malformations, transposition complex). The defects, which were until now the field of embryologist and pathologist, require accurate and precise clinical diagnosis of the anomaly. The purpose of this analysis was to estimate the ability of angiocardiography for diagnosis of bulboventricular malformations considering the type of essential anomaly, its exact morphology and character of coexisting malformations. The report represents 49 cases with pathological diagnosis of bulboventricular malformations in children, in which during hospitalization angiocardiography has been performed. The cases were selected from 1918 angiocardiographies and also from 987 cases of pathological specimens with congenital heart diseases in the years 1970-1977. There were: 33 cases of TGA, in these 2 with corrected TGA, 3 cases of DORV, 1 case of DOLV , 12 cases of CV. All cases showed the broad spectrum of variants in position of the great arteries and kind of conus apart from type of basic anomaly. Septal defects, pulmonary orifice stenosis or atresia and anomalies of atrio-ventricular orifices particularly in common ventricle were mostly coexisting malformations. To recognize essential anomaly we estimated atrio-ventricular and ventriculo-arterial relation (connection), based on Kirklin classification. The conuses and position of the trunk of the great arteries were treated as pathomorphologic details, that had no influence on essential diagnosis of malformation. Arbitrary accepted definition and nomenclature was based on data from bibliography. Angiocardiography was made using full-size filmchanger AOT with maximal frequency 6 frames/sec. Contrast medium injected mainly into the ventricles. X-rays were performed usually immediately in two projections. Comparison of the angiocardiographic diagnosis with pathology of the hearts showed the correct diagnosis of the essential malformation, by means of angiocardiography, in more than 80% cases. But the diagnosis percentage in particular elements of malformation varied from 2/3 to 1/3 according to the type of malformation. The absence of the correct diagnosis of the essential anomaly, based on type of relations, was the lack of visualization of all heart cavities (in some cases), which was conditioned by the method. On the other hand the correct angiocardiographic diagnosis was sometimes impossible, because of very complicated anatomical situation in malformed hearts.(ABSTRACT TRUNCATED AT 400 WORDS)

Angiocardiography↗

Quantitative radionuclide angiocardiography: detection and quantitation of left to right shunts.

In 105 patients defection and quantitation of left to right shunts was performed using quantitative radionuclide angiocardiography. The radionuclide angiocardiograms were acquired and analyzed by a gamma camera interfaced to a digital computer system. Pulmonary to systemic flow (Qp/As) ratios were calculated by analysis of pulmonary time-activity histograms using a gamma variate model. All patients were studied with cardiac catheterization, left ventricular angiocardiography and radionuclide angiocardiography. The radionuclide method allowed precise detection and quantitation of left to right shunts with a Qp/Qs ratio of 1.2 to 3.0. There was good agreement between the Ap/As ratio calculated by oximetry at cardiac catheterization and radionuclide angiocardiography (r = 0.94). The information gathered with this nontraumatic method appears sufficiently reliable to be used in the management of patients.

Adult↗

A modified technique for transseptal angiocardiography: review of 186 cases.

Perforations of the left atrial or ventricular wall and extravasations of contrast medium during transseptal left heart catheterisation or angiocardiography can be eliminated by replacing the normally used transseptal catheters by Pigtail-catheters. With only 2.8% minor complications without sequelae in 181 successful studies, transseptal angiocardiography of the left heart through Pigtail-catheters is not only less hazardous than injections through the transseptal catheters used up to now, but possibly bears even less risk than direct retrograde injection into the left ventricle. The best method of showing the left atrial cavity and the mitral valve is transseptal left atrial injection. According to our findings in the evaluation of the ventricular function by means of quantitative angiocardiography, transseptal angiocardiography with injection into the left atrium is preferable to retrograde direct ventriculography, as ventricular ectopic beats were absent and supraventricular ectopic beats were as rare as 5% of cases. With this method, local disturbances of wall motion during injection could also be avoided and one or two more cycles could be evaluated before the depressant effect of contrast medium started.

Angiocardiography↗

[Modern differentiation possibilities of angiocardiography in childhood].

1. Angiocardiography plays an irreplaceable method of investigation in the diagnosis of cardiac diseases in infancy and childhood. In many cases it is the "crown" of the diagnosis. 2. Cine-angiocardiography is indispensable in paediatric cardiology. In infancy, in rapid heart rates and in complicated malformations of the heart, only a movie film (35 mm) can register completely all the anatomic and haemodynamic details. 3. In certain cases the serial angiocardiography is also necessary in childhood. Today two methods of radiography can be made use of: the direct recording by means of rapid film changers on full size X-ray films and the indirect method on 70- or 100-mm size films. 4. According to our experience, the serial angiocardiography recordings on 70-mm size films have more advantages than the usual full size films (35 x 35 cm). In the interpretation of the 70-mm-size films there is no loss of information, and the radiators dose is 1/10 lower than in AOT-size.

Age Factors↗

Regional dysfunction by equilibrium radionuclide angiocardiography: a clinicopathologic study evaluating the relation of degree of dysfunction to the presence and extent of myocardial infarction.

The relation of degree of regional wall motion abnormality by equilibrium radionuclide angiocardiography to the presence and mural extent of regional necrosis or scar at autopsy was evaluated in 23 autopsy patients who had a history of myocardial infarction and had equilibrium radionuclide angiocardiography within 40 days of death. Of the 228 regions evaluated by equilibrium radionuclide angiocardiography, 135 had abnormal regional wall motion and 102 (76%) of these 135 regions had evidence of myocardial infarction at autopsy. The overall sensitivity, specificity and predictive values of regional wall motion abnormality for regional necrosis or scar were 69, 59 and 76%, respectively. Of the 33 false positive regions, 20 (61%) had severe narrowing of the coronary artery supplying that region, 13 (39%) were adjacent to a region with a myocardial infarction and almost half (16 [48%]) were in the lateral wall. Eighty-three (36%) of the 228 regions were akinetic or dyskinetic, 52 (23%) were hypokinetic and 93 (41%) were normal. Sixty-three (76%) of the 83 akinetic/dyskinetic segments had transmural myocardial infarction at autopsy, 14 (17%) had nontransmural myocardial infarction and only 6 (7%) contained no necrosis or scar. In contrast, 14 (27%) of 52 hypokinetic segments had transmural myocardial infarction, 11 (21%) had nontransmural myocardial infarction and 27 (52%) were normal. Thus, the most severe regional wall motion abnormality (akinesia/dyskinesia) almost always indicates regional myocardial infarction which is usually transmural whereas less severe dysfunction (hypokinesia) is not necessarily associated with regional necrosis or scar. The severity of regional dysfunction must be considered if equilibrium radionuclide angiocardiography is used to evaluate the presence and mural extent of myocardial infarction within a region.

Adult↗

Tracheobronchography and angiocardiography of paediatric cardiac patients with airway disorders.

OBJECTIVE: We report our experience in combining tracheobronchography and angiocardiography in the assessment of a selected cohort of paediatric cardiac patients with problematic airway disorders. METHODOLOGY: The clinical records of 11 patients who underwent 17 studies at a median age of 5.5 months (range 3 months to 10.8 years) were reviewed. Tracheobronchography and angiocardiography were performed under general anaesthesia using a non-ionic contrast agent. The findings were compared with those of flexible bronchoscopy and magnetic resonance imaging (MRI). RESULTS: Seven patients had cardiac lesions associated with vascular anomalies potentially compressing the airway, while four had no identifiable aberrant or enlarged vessels. All examinations but one were performed without complications. Tracheobronchography demonstrated extrinsic vascular compression with secondary airway malacia in three (27%), intrinsic tracheobronchial stenosis in five (45%), and airway malacia in three patients (27%). Precise measurement of the airway calibre and real-time fluoroscopic monitoring facilitated transcatheter tracheobronchial interventions (six balloon dilations, three stent implantations) in four patients. In conjunction with angiocardiography, cine-tracheobronchography provided detailed information on the spatial relationship between vascular and airway structures in all patients; allowed dynamic assessment of airway malacia; and facilitated preoperative planning in six patients. In contrast, bronchoscopy failed to differentiate malacia from extrinsic compression in four patients (36%), while MRI, performed in six patients, was unsatisfactory in one due to a motion artefact and failed to diagnose airway malacia and extrinsic compression in three patients. CONCLUSIONS: Tracheobronchography is relatively safe in paediatric cardiac patients. Combined tracheobronchography and angiocardiography, a less operator-dependent imaging modality compared to bronchoscopy and MRI, delineated the airway and vascular anatomy in detail; facilitated preoperative planning; and permitted transcatheter tracheo-bronchial interventions. The dynamic capability of tracheobronchography supplements that of flexible bronchoscopy and MRI in the diagnosis of airway malacia.

Airway Obstruction↗

Evaluation of left ventricular performance and of its reserve by radionuclide angiocardiography: comparison with other methods.

This study was performed, i) to compare radionuclide angiocardiography with the other methods, and ii) to evaluate its usefulness in investigating left ventricular performance and its reserve. Radionuclide angiocardiography, chest X-ray film, chest X-ray cinegraphy, echocardiography, two-dimensional echocardiography, pulsed Doppler flowmetry, cardiokymography, myocardial imaging, contrast ventriculography and coronary arteriography were performed (:also at exercise) in 105 subjects including various kinds of cardiac patients. Radionuclide angiocardiography could be performed both at rest and at exercise, contrary to invasive methods. In detailed analysis of left ventricular mechanics in non-ischemic heart disease, echocardiography at rest and at exercise may be appropriate, because of its high image resolution. In evaluation of ischemic heart diseases, radionuclide angiocardiography at rest and at exercise might be appropriate, because of bidirectional informations and its high success rate. Two-dimensional echocardiography with M-mode echocardiography might compensate for it, particularly for continuous informations during exercise. Detection of regional wall motion dysfunction at exercise is more specific than exercise ECG and is more sensitive than exercise myocardial imaging. From many kinds of examinations, appropriate one should be selected according to the purpose of investigators. Much more technical progress in these methods can be expected.

Adolescent↗

The role of exercise radionuclide angiocardiography in predicting future cardiac events in patients with acute myocardial infarction.

UNLABELLED: Left ventricular ejection fraction (LVEF) during exercise radionuclide angiocardiography is a useful prognostic index for patients with acute myocardial infarction (AMI). However, most previous studies were performed before reperfusion therapies (i.e., thrombolysis and coronary angioplasty) were widely used. Therefore, because reperfusion therapy has become a standard therapeutic option, we reexamined the prognostic value of rest LVEF and exercise LVEF determined by radionuclide angiocardiography in patients with AMI at the time of hospital discharge. METHODS: The retrospective analysis included 419 consecutive patients with AMI who underwent ergometric stress radionuclide angiocardiography before hospital discharge, 44 +/- 14 d after the onset of AMI. RESULTS: During a mean follow-up of 4.6 y, cardiac events occurred in 101 (24.1%) patients. Cardiac events included recurrent MI (33 patients, 7.9%), unstable angina (49 patients, 11.7%), congestive heart failure (16 patients, 3.8%), and ventricular tachycardia (3 patients, 0.7%). The LVEF at peak exercise was significantly lower in the group with cardiac events (P = 0.0140). However, no significant difference was observed in the rest LVEF between patients with and without cardiac events. On the basis of multivariate analysis using a Cox proportional hazards model, only peak LVEF (P = 0.0246) was found to be an independent predictor of cardiac events. In the patient subsets with a peak LVEF >50% or <50%, the event-free rate was 81.0% versus 62.4% (P = 0.0007), respectively. Regardless of the presence or absence of reperfusion therapy, the lower peak LVEF was associated with a decrease in the event-free survival rate. CONCLUSION: In the current reperfusion era, the lower peak LVEF as measured by radionuclide angiocardiography at the time of discharge is a useful predictor of subsequent cardiac events in patients with AMI.

Angioplasty, Balloon, Coronary↗