ANGIOGRAPHY

Also known as Cardiac Catheterization

PREPARED BY:Sharmin Susiwala

• Angio- Vessel• Graphy- Visualization• “Visualization of vessels is angiography”• Variants:o Arteriography- visualization of arterieso Venography- visualization of veins• Types:o Coronaryo Cerebralo Abdominalo Peripheral

• In this technique a specially designed catheter is inserted into a vein or artery and advanced into the heart under X-ray guidance.

• Indications:• Measure intracardiac pressures• Take blood samples from individual cardiac chambers

to measure the concentration of ischaemic metabolites (e.g. lactate) and the oxygen content.These estimations are used to gauge ischaemia, quantify intracardiac shunts and measure cardiac output.

• Obtain angiograms by injecting contrast media into a chamber or blood vessel

RIGHT HEART CATHETERIZATION:• The right heart is catheterized by introducing the catheter

into a peripheral vein (usually the right femoral or internal jugular vein) and advancing it through the right atrium and ventricle into the pulmonary artery.

• Right heart catheterisation is used to assess pulmonary artery pressure and can also be used to detect intracardiac shunts by measuring oxygen saturation in different chambers.

• Cardiac output can also be measured using thermodilution techniques.

• A satisfactory approximation to left atrial pressure can be obtained by 'wedging' an end-hole or balloon catheter in a branch of the pulmonary artery.

• Swan-Ganz balloon catheters are often used to monitor pulmonary 'wedge' pressure as a guide to left heart filling pressure in critically ill patients

• LEFT HEART CATHETERIZATION:• Left heart catheterization is usually performed via the right femoral

artery, although the brachial and radial arteries are sometimes used in patients with significant peripheral vascular disease.

• A pigtail catheter is advanced up the aorta and manipulated through the aortic valve into the left ventricle.

• Pressure tracings are taken from the left ventricular cavity.• The end diastolic pressure is invariably elevated in patients with left

ventricular dysfunction. • A power injection of radio opaque contrast material is used to

opacify the left ventricular cavity (left ventriculography) and thereby assesses left ventricular systolic function.

• The catheter is then withdrawn across the aortic valve into the aorta and the ‘pullback’ gradient across the valve is measured.

• Aortography(a power injection into the aortic root) can be performed to assess the aortic root and the presence and severity of aortic regurgitation.

• Digital subtraction angiography::::: This technique permits the injection of small

volumes of radio-contrast agents during cardiac catheterization with the production of computer-analysed high-quality angiograms.

Unfortunately, peripheral injection of contrast does not give adequate visualization of the coronary arteries, but aortic lesions can be visualized.