Angiocardiography

Angiocardiography (from the Greek. angeion - vessel, kardia - heart and grapho - writing, picture) is the method of roentgenologic examination, allowing to receive a shadow image of the cavities of the heart and main vessels through the introduction of a contrast medium.
Angiocardiography is a chain addition to the usual x-ray study, and applies primarily to clarify the nature of congenital heart diseases. Lower utilization was angiocardiography in the diagnosis of acquired heart diseases and other heart diseases. Sometimes angiocardiography produced only for the study of the arteries and veins of the lungs (pulmonary), mainly with the purpose of studying of the pulmonary circulation for some diseases (see Angiography).
As a contrast agent in angiocardiography in the clinics of the USSR used the Soviet drug cardiotest, representing an organic compound of iodine. Cardiotest (usually 70% aqueous solution) and similar foreign medicines (jouron, palosi, diodon, detract) imposed at the rate of 1 ml per 1 kg of body weight investigated.
The greatest distribution was received intravenous angiocardiography, in which the contrast agent is injected into the bloodstream through a peripheral vein that allows you to trace the path of blood flow from the past to the aorta. Selective contrast of the left heart chambers shall: 1) using direct percutaneous puncture of the left ventricle; 2) by means of retrograde catheterization of the left ventricle through peripheral artery; 3) method transseptal catheterization left heart (through the femoral vein in the right atrium, a catheter is inserted with needle and after the puncture atrial septal catheter is pushed into the left atrium and left ventricle, where it merges with the contrast agent). At intravenous angiocardiography contrast solution most often poured through the cannula into the prepared under local anesthesia v. basilica. In order to obtain a sufficiently intensive image of the heart and large vessels of the contrast agent is administered as soon as possible for 1-2 seconds.
Special devices designed for angiocardiography, produce within a few seconds, a considerable number of pictures that enables to study in detail the way of the bloodstream. However, the nature of some congenital heart defects are often able to specify only 3-6 shots made for 6-10 seconds. (respectively the speed of blood flow) conventional x-ray machine, moving while shooting cassette with film manually or using simple mechanical devices.
OK there is a certain sequence of filling by contrast agent cavities of the heart and main vessels: in the picture, made by 0.5 sec. from the beginning of introduction in v. basilica contrast solution, the latter fills subclavian, anonymous and upper ultimate Vienna; in another half second it is defined in the right atrium (Fig. 1); in 2-3 seconds. kontroliruyut right ventricle and pulmonary artery and its ramifications (Fig. 2); on 5-8th sec. (depending on the age of the studied) - the veins of the lungs and the left atrium, and after 1-2 seconds.- the cavity of the left ventricle and the aorta (Fig. 3).
In congenital malformations there are some variations in the sequence of filling a contrast solution separate cavities of the heart or great vessels. So, contrasting the left atrium immediately after the right indicates the presence of atrial septal defect. When tetralogy of Fallot, which aorta departs from both ventricles photos taken in 1-2 seconds. from the beginning of the introduction of a contrast agent, you can see it from the right ventricle comes simultaneously in the pulmonary artery and the aorta (Fig. 4). Pathognomonic angiocardiografia picture at coarctation of the aorta. Angiocardiography, especially by direct injection of a solution of contrast in the aorta (see Aortography), allows not only to establish a narrowing of the aorta, but also to determine its extent and location, and the length. Angiocardiography significantly facilitates the recognition and other birth defects - open arterial duct disease, Eisenmenger, common arterial trunk, full of movement of the main vessels, etc. When acquired defects mitral angiocardiography (mainly selective contrast of the left heart chamber) helps to determine the degree of mitral stenosis and mitral insufficiency and state valve apparatus. In aortic vices angiocardiography also specifies type of blemish and anatomical changes semilunar valve of aorta. Typical changes often reveals angiocardiography and atherosclerosis of aorta aneurysms of the aorta and the pulmonary artery, vpotnye the pericarditis and some other cardiovascular diseases.

Fig. 1-3. Angiocardiography normal heart obtained by injection of a contrast agent in v. basilica dext.
Fig. 1. On the 1-th second of the contrast agent fills subclavian, anonymous and upper ultimate Vienna, as well as the right atrium. Fig. 2. On the 3-th second of the contrast agent fills the right ventricle and the pulmonary artery with its branches. Fig. 3. On the 8-th second of the contrast agent fills the left atrium, left ventricle and the aorta. Fig. 4. Angiocardiography patient 5 years (tetralogy of Fallot), produced in 2 seconds after injection of a contrast agent in v. basilica dext. Contrasting substance of the right ventricle was received mainly in the aorta and only a small amount of it penetrated into the pulmonary artery.