CONTRAST CINE LEFT VENTRICULOGRAPHY - COMPARISON OF 2 PIGTAIL CATHETER SHAPES AND ANALYSIS OF FACTORS DETERMINING THE FINAL QUALITY

Ventricular arrhythmias or inadequate opacification of the ventricular cavity during contrast-cine left ventriculography frequently interfer e with evaluation of regional wall motion, ejection fraction or mitral regurgitation. In this prospective, randomized study traditional (str aight) pigtail catheter was compared with a new, large loop pigtail ca theter (both 6 French, large lumen) in terms of the quality of the cin e left ventriculograms. Straight (Group I) and curved pigtail (Group I I) groups were further subdivided randomly into a preset (13 cc per se cond for 3 seconds with a pressure rise time of 0.5 seconds) injection rate (Group IA, n = 48, and Group IIA, n = 48) or operator definded i njection rate (Group IB, n = 49, and Group IIB, n = 45) subgroups. The ventricular tachycardia and couplets occurred at similar frequency am ong the groups, The curved pigtail subgroups showed significantly more frequent catheter induced mitral regurgitation. However, the opacific ation and overall quality of the left ventriculograms were distributed similarly between the groups. Because the catheter type and injection protocol did not affect the left ventriculogram quality in our study, variables determining opacification and overall quality rating are an alyzed in the overall group of 190 patients. Left ventricular opacific ation was excellent in 72, acceptable in 108 and marginal in 10 patien ts. The patients with marginal opacification were significantly heavie r (P = .004) with larger left ventricular enddiastolic volumes (P = .0 19), and smaller amount of contrast volume per enddiastolic volume (P = .005) and kilogram body weight (P = .003). The overall quality of le ft ventriculograms were excellent in 38, acceptable in 133, and margin al in 19 patients. The patients with excellent left ventriculograms we re significantly younger (P = .019) and slightly less heavy (P = 0.09) . Significantly more female patients were also in this group (P = .036 ). Ventricular tachycardia was the most common cause of unsatisfactory left ventriculograms, In the RAO view, deeper (more apical) placement of the catheter was associated with higher incidence of ventricular t achycardia (63%), The most ''silent'' area was the posterobasal area. In conclusion, the perfect left ventriculogram remains to be an elusiv e goal in routine clinical practice. When using 6F highflow pigtail ca theters and nonionic contrast agents, more basal catheter position and higher contrast volume increase the quality of the left ventriculogra ms. (C) 1996 Wiley-Liss, Inc.