Angiocardiography

Description:

Angiocardiography (from Greek angeion — a vessel, kardia — heart and grapho — I write, I represent) — the method of X-ray inspection allowing to receive the shadow image of cardial cavities and the main vessels by introduction to them of a contrast agent.
The angiocardiography is chain addition to usual X-ray inspection and is applied mainly to specification of nature of inborn heart diseases. Smaller use was received by angiocardiography at diagnosis of the acquired defects and other heart diseases. Sometimes angiocardiography make only for a research of arteries and veins of lungs (angiopulmonografiya), it is preferential for the purpose of studying of pulmonary blood circulation at some diseases.
As a contrast agent at angiocardiography in clinics of the USSR use the Soviet drug Cardiotrastum representing organic compound of iodine. And similar foreign drugs (Ioduronum, piyelozit, Diodonum, Diodrastum) enter Cardiotrastum (usually 70% aqueous solution) at the rate of 1 ml of solution on 1 kg of the body weight investigated.
The greatest distribution was gained by intravenous angiocardiography at which a contrast agent is entered into a blood channel through a peripheral vein that allows to track all way of a blood-groove from the last to an aorta. Selective contrasting of the left cameras of heart is carried out: 1) by means of a direct transdermal puncture of a left ventricle; 2) by retrograde catheterization of a left ventricle through a peripheral artery; 3) by method of transseptal catheterization of a left heart (through a femoral vein the catheter with a needle is entered into the right auricle and after a puncture of an interatrial partition the catheter moves ahead in the left auricle or a left ventricle where a contrast agent joins). At intravenous angiocardiography most often pour in contrast solution through a cannula in v. basilica, otpreparirovanny under a local anesthesia. For obtaining rather intensive image of heart and large vessels a contrast agent is entered as soon as possible — for 1—2 sec.
The special devices designed for angiocardiography make a significant amount of pictures within several seconds that allows to study a way of a blood-groove in detail. However the nature of some inborn heart diseases quite often manages to be specified only 3 — 6 pictures executed for 6 — 10 sec. (according to blood-groove speed) a usual X-ray apparatus, moving during shooting of the cartridge with a film manually or by means of simple mechanical devices.
A certain sequence of filling with a contrast agent of cardial cavities and the main vessels is normal observed: in the picture made in 0,5 sec. from the beginning of introduction to v. basilica of contrast solution the last fills subclavial, anonymous and upper hollow veins; still it is defined by half a second in the right auricle; on 2 — the right ventricle, a pulmonary artery and its branchings are contrasted 3rd sec.; on 5 — 8th sec. (depending on the age investigated) — veins of lungs and the left auricle, and in 1 — 2 sec. — a cavity of a left ventricle and an aorta.
At inborn defects these or those deviations in the sequence of filling with contrast solution of separate cardial cavities or large vessels are observed. So, contrasting of the left auricle immediately after right indicates existence of defect of an interatrial partition. At a tetrad of Fallo at which the aorta departs from both ventricles in the picture made in 1 — 2 sec. from the beginning of administration of contrast medium it is visible how it from a right ventricle comes at the same time to a pulmonary artery and to an aorta. Patognomonnchna an angiokardiografichesky picture at aorta coarctation. The angiocardiography, especially at direct administration of solution of a contrast agent in an aorta, allows not only to establish an aortostenosis, but also to define its degree, localization and extent. The angiocardiography significantly facilitates recognition and other inborn defects — an open arterial channel of a disease of Eyzenmenger, the general arterial trunk, full movement of the main vessels, etc. At the acquired mitral defects the angiocardiography (mainly selective contrasting of the left cameras of heart) promotes definition of degree of a mitral stenosis and mitral insufficiency and a condition of the valve device. At aortal defects the angiocardiography also specifies a type of defect and anatomic changes of semi-lunar valves of an aorta. Characteristic changes are quite often revealed by angiocardiography and at aorta atherosclerosis, aortic aneurysms and a pulmonary artery, a vypotny pericardis and some other cardiovascular diseases.