Aortic insufficiency cardiac catheterization: Difference between revisions
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===Aortography Procedure=== | ===Aortography Procedure=== | ||
A 4-6 F pigtail catheter is generally used to perform [[aortography]]. The pigtail catheter is placed a few centimeters above the [[aortic root]]. For aortic insufficiency quantification, the catheter is placed in the [[aortic root]] approximately 2 cm above the [[aortic valve]]. The image intensifier is placed in the 45 degree left anterior oblique view with no cranial or caudal angulation. Usually a total of 40 to 50 cc of dye is injected with approximately 20 cc administered every second. The patients should be informed that they can have a warm feeling throughout their body. | A 4-6 F pigtail catheter is generally used to perform [[aortography]]. The pigtail catheter is placed a few centimeters above the [[aortic root]]. For aortic insufficiency quantification, the catheter is placed in the [[aortic root]] approximately 2 cm above the [[aortic valve]]. The image intensifier is placed in the 45 degree left anterior oblique view with no cranial or caudal angulation. Usually a total of 40 to 50 cc of dye is injected with approximately 20 cc administered every second. The patients should be informed that they can have a warm feeling throughout their body. | ||
===Grading Aortic Insufficiency=== | ====Grading Aortic Insufficiency==== | ||
Grading the severity of aortic insufficiency is based on the amount of opacification of the [[left ventricle]], two complete [[cardiac cycle]]s after injection compared to that of the [[aortic root]]. | Grading the severity of aortic insufficiency is based on the amount of opacification of the [[left ventricle]], two complete [[cardiac cycle]]s after injection compared to that of the [[aortic root]]. | ||
*Grade 1 | *Grade 1 | ||
Revision as of 20:02, 30 January 2013
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Aortic Regurgitation Microchapters |
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Acute Aortic regurgitation |
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Chronic Aortic regurgitation |
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Aortic insufficiency cardiac catheterization On the Web |
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American Roentgen Ray Society Images of Aortic insufficiency cardiac catheterization |
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Risk calculators and risk factors for Aortic insufficiency cardiac catheterization |
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Varun Kumar, M.B.B.S.; Lakshmi Gopalakrishnan, M.B.B.S.
Overview
Although echocardiography is now the primary imaging modality used to evaluate aortic insufficiency, cardiac catheterization is often performed in patients with aortic insufficiency primarily to assess for the presence of epicardial coronary artery disease prior to surgical aortic valve replacement. Aortography can also be performed to assess the severity of aortic insufficiency. The presence or absence of an aortic dissection can be evaluated. Left ventricular function (hemodynamics), size, and systolic function (ejection fraction) can also be evaluated.
Cardiac Catheterization
Cardiac catheterization is the insertion of a catheter into a chamber or vessel of the heart. This is done for both investigational and interventional purposes. Coronary catheterization is a subset of this technique, involving the catheterization of the coronary arteries.
Aortography Procedure
A 4-6 F pigtail catheter is generally used to perform aortography. The pigtail catheter is placed a few centimeters above the aortic root. For aortic insufficiency quantification, the catheter is placed in the aortic root approximately 2 cm above the aortic valve. The image intensifier is placed in the 45 degree left anterior oblique view with no cranial or caudal angulation. Usually a total of 40 to 50 cc of dye is injected with approximately 20 cc administered every second. The patients should be informed that they can have a warm feeling throughout their body.
Grading Aortic Insufficiency
Grading the severity of aortic insufficiency is based on the amount of opacification of the left ventricle, two complete cardiac cycles after injection compared to that of the aortic root.
- Grade 1
- Brief and incomplete ventricular opacification. Clears rapidly.
- Grade 2
- Moderate opacification of the ventricle that clears in less that 2 cycles. Never greater than aortic root opacification.
{{#ev:googlevideo|2835396102193538399}}
- Grade 3
- Opacification of the ventricle equal to aortic root opacification within 2 cycles. Delayed clearing of ventricle over several cycles.
{{#ev:googlevideo|7844772248158567311}}
- Grade 4
- Opacification of the ventricle almost immediately that is greater than that of the aortic root with delayed clearing of the ventricle.
{{#ev:googlevideo|1323435585463870537}}
Coronary Angiography in Aortic Insufficiency
As a result of the regurgitant flow into the left ventricle, there is greater than normal flow in the coronary arteries that tends to dilute the contrast. It can be quite difficult to fill the coronary arteries during a standard injection.
2008 Focused Update Incorporated into the 2006 ACC/AHA Guidelines for the Management of Patients with Valvular Heart Disease (DO NOT EDIT)[1]
Cardiac Catheterization Indications (DO NOT EDIT)[1]
| Class I |
| "1. Cardiac catheterization with aortic root angiography and measurement of LV pressure is indicated for assessment of severity of regurgitation, LV function, or aortic root size when noninvasive tests are inconclusive or discordant with clinical findings in patients with AR. (Level of Evidence: B)" |
| "2. Coronary angiography is indicated before AVR in patients at risk for CAD. (Level of Evidence: C)" |
| Class III |
| "1. Cardiac catheterization with aortic root angiography and measurement of LV pressure is not indicated for assessment of LV function, aortic root size, or severity of regurgitation before AVR when noninvasive tests are adequate and concordant with clinical findings and coronary angiography is not needed. (Level of Evidence: C)" |
| "2. Cardiac catheterization with aortic root angiography and measurement of LV pressure is not indicated for assessment of LV function and severity of regurgitation in asymptomatic patients when noninvasive tests are adequate. (Level of Evidence: C)" |
Sources
- 2008 focused update incorporated into the 2006 ACC/AHA guidelines for the management of patients with valvular heart disease[1]
References
- ↑ 1.0 1.1 1.2 Bonow RO, Carabello BA, Chatterjee K; et al. (2008). "2008 Focused update incorporated into the ACC/AHA 2006 guidelines for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons". Circulation. 118 (15): e523–661. doi:10.1161/CIRCULATIONAHA.108.190748. PMID 18820172. Unknown parameter
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