Ventriculography and aortography
Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead in Cardiovascular Catheterization and Intervention, 2017
Aortography is the radiographic technique used to opacify the lumen of the aorta, the superior aspect of the aortic valve leaflets, and all of the vessels that arise from the aorta.[26] Noninvasive radiographic evaluation of the aorta and its branches has evolved rapidly because of advancements in imaging techniques such as computed tomography angiography (CTA) and magnetic resonance angiography (MRA). Nevertheless, catheter-based angiographic evaluation remains an integral part of the diagnostic process and the main guide to choosing an intervention (either endovascular or surgical). An ascending aortogram allows one to determine the competency of the aortic valve, the anatomy and diameter of the ascending thoracic aorta, and the presence of aortic dissection or of patent aortocoronary bypass grafts. When the catheter is positioned proximal to the innominate artery, the examiner may evaluate the anatomy of the aortic arch and its major arterial branches (e.g., to guide percutaneous revascularization of the subclavian or the carotid arteries), detect the presence of a persistent ductus arteriosus or coarctation, and gain information about the descending thoracic aorta. When the catheter is positioned more distally, one may evaluate aneurysms, dissections, and abnormalities of the abdominal aorta and its arterial branches (Figure 21.9).
Endovascular repair of pararenal and thoracoabdominal aneurysms
Sachinder Singh Hans, Alexander D Shepard, Mitchell R Weaver, Paul G Bove, Graham W Long in Endovascular and Open Vascular Reconstruction, 2017
Before the stent graft is placed, the target vessels must be localized to align the branches or fenestrations. This can be done with a variety of techniques, such as the fusion imaging described earlier. Alternatively, aortography can be performed. However, the author prefers to supplement the use of fusion imaging with the placement of catheters and wires in at least one of the target vessels to mark their location (Figure12.7). While fusion imaging is helpful in assisting the placement of fenestrated/branched endografts, its accuracy is diminished in anatomies where there is significant vessel tortuosity. In these situations, with advancement of the stiff endograft systems, the location of the target vessel can shift making the location of the overlaid image inaccurate. When advancing the endograft, the additional placement of “marker” catheters can assist in positioning it along the length of the aortic axis and helping to align the branches/fenestrations with the target vessels without the use of contrast. Typically, if one target vessel is offset (usually in a cranial/caudal position), all the target vessels will be shifted similarly.
Principles of arteriography
Peter A. Schneider in Endovascular Skills: Guidewire and Catheter Skills for Endovascular Surgery, 2019
The technique of arterial puncture is described in Chapter 2. After the optimal puncture site is selected, access is obtained and the guidewire placed in the desired location. The usual initial guidewire choice for routine strategic arteriography is a floppy tip, 0.035-inch diameter, 145-cm length starting wire (see Chapter 4, Table 4.1). The guidewire is advanced to a location where the floppy tip is several centimeters beyond the intended location of the catheter head. Aortography is usually performed with a pigtail, tennis racket, or other flush catheter that has many side holes and is able to create a contrast blush in a short period of injection time. Catheter types and lengths are discussed in Chapter 6. Catheter placement for aortography is based on fluoroscopically visible landmarks (Figure 10.2). Arch aortography is performed with the catheter head in the ascending aorta, distal to the coronary ostia but proximal to the innominate artery. Thoracic aortography is performed with the catheter head placed just distal to the left subclavian origin, usually at the location where the aorta begins to straighten to descend into the thorax. The paravisceral segment of the aorta is seen best when the catheter is placed at or just proximal to the level of the diaphragm. A lateral projection is required to evaluate the celiac and superior mesenteric arteries in profile. Aortorenal arteriography requires catheter head placement at or just below the level of the renal arteries, usually over the first lumbar vertebral body or at the junction of the first and second lumbar vertebral bodies (see Chapter 7, Figure 7.1). More details about catheter head placement are provided in later sections that describe different types of arteriograms.
Pathways Towards Lean TAVR
Published in Structural Heart, 2020
Maarten P. Van Wiechen, Joris F. Ooms, Thijmen W. Hokken, Marjo J. De Ronde-Tillmans, Jeannette A. Goudzwaard, Joost Daemen, Peter P. De Jaegere, Francesco U. Mattace-Raso, Nicolas M. Van Mieghem
Local anesthesia precludes the use of transesophageal echocardiography (TEE) during the procedure, which is traditionally used for paravalvular leak (PVL) assessment. In our practice, TEE has been replaced by the integration of contrast aortography and calculation of the aortic regurgitation index (ARI). The ARI is the ratio of the transvalvular gradient to systolic blood pressure, where the transvalvular gradient is determined by the difference between diastolic blood pressure and left ventricular end-diastolic pressure. ((DBP – LVEDP/SBP)x100)21 (Figure 1). Using the dicrotic notch index (DNI) to assess for PVL is currently under investigation.22 The DNI does not require LV measurements, alleviating the need for a LV pigtail, which can further strip down the TAVR-procedure.
Quantitative assessment of aortic regurgitation following transcatheter aortic valve replacement
Published in Expert Review of Cardiovascular Therapy, 2021
Mitsunobu Kitamura, Maximilian Von Roeder, Mohamed Abdel-Wahab
The major advantage of using these invasive parameters is the possibility of immediate evaluation during the index procedure, which is relevant for the decision-making process for additional corrective procedures after THV implantation. Indeed, the combination of aortography and hemodynamic assessment has been routinely integrated in the clinical setting, whereas transthoracic (or transoesophageal) echocardiography is useful to specify the mechanism of AR and to optimize the following therapeutic decision. As a major limitation, these parameters require an invasive left-sided catheterization and simultaneous pressure recording of the aorta and LV, which narrows the utilization for the immediate implantation setting and not for follow-up assessment.
Management of severe hemoptysis
Published in Expert Review of Respiratory Medicine, 2018
Antoine Parrot, Sebastian Tavolaro, Guillaume Voiriot, Antony Canellas, Jalal Assouad, Jacques Cadranel, Muriel Fartoukh
In terms of the mechanism of bleeding, MDCTA can reveal aortic dissection (which sends the patient to a vascular surgery department) or rupture of a large vessel by a tumor.MDCTA can detect a suspected pulmonary mechanism, especially if there is necrotic opacity accompanied by an irregular or aneurysmal pulmonary artery or bubbles in the pulmonary artery wall [43] (Figure 3).MDCTA can detect a bronchial or non-bronchial mechanism. Bronchial arteries larger than 2 mm should be deemed pathological [44]. Non-bronchial arteries, which cause hemoptysis in 46–88% of cases, should be checked whenever there is pleural thickening of more than 3 mm, or a phrenic artery or internal mammary artery whose diameter exceeds 3 mm [37]. MDCTA can accurately map the bronchial arteries (whether of normal or ectopic origin) and non-bronchial arteries (including the phrenic artery and internal mammary artery) causing the hemoptysis. This renders any full aortography during bronchial arteriography unnecessary, thereby preventing any additional radiation of the patient and radiology staff [13,25,44,45]. In terms of mapping, this modality is deemed superior to bronchial arteriography to such an extent that if hemoptysis recurs either the original MDCTA is reinterpreted or another MDCTA is performed if the technique was not quite right [29,39]. However, the anterior spinal artery may currently only be seen on bronchial arteriography.
Related Knowledge Centers
- Aorta
- Aortic Dissection
- Common Iliac Artery
- Sensitivity & Specificity
- Femoral Artery
- Catheter
- Radiocontrast Agent
- X-Ray
- Lumen
- Gold Standard
- Sensitivity & Specificity