Catheters used for right ventricular angiography

What are the types of catheters used for right ventricular angiography?

Catheters used for right ventricular angiography: NIH (National Institute of Health) catheter with no end hole and a few side holes and a balloon tipped Berman angiographic catheter are the usual catheters used for right ventricular angiography. In Berman angiographic catheter, since the balloon is at the tip, the holes are seen about one centimeter proximal to the tip of the catheter. If the balloon has been deflated prior to angiography, the pattern of dye efflux, originating about 1 cm proximal to the tip is suggestive of Berman angiographic catheter, while in the NIH catheter, the holes are quite near the tip, on the sides.

Berman angiographic catheter being a flow directed catheter, is useful to enter the right ventricle in small infants with complex anatomy. The balloon is inflated when the catheter tip reaches the right atrium so that it is directed further by the natural blood flow within the heart. As the balloon separates the jet of contrast being injected from the ventricular wall, chance of ventricular arrhythmia and perforation are reduced.

NIH catheter being a stiffer catheter, may not be a good option in small infants with complex cardiac anatomy.

Flow directed Berman angiographic catheter has also been used for aortofemoral arteriography by the axillary artery approach when the retrograde approach and translumbar approach are not feasible. Flow direction is boon when the aorta is very tortuous [1].

It may be noted that balloon tipped catheters were used by Swan HJC et al to access pulmonary arteries without fluoroscopy [2]. Later adding multiple side holes to such catheters made it possible to inject sufficient contrast to get angiographic details as well [3].

References

1. E Buonocore, T P Lynch. Flow-directed Balloon Catheterization for Aortofemoral Arteriography Using the Axillary Artery Approach. AJR Am J Roentgenol. 1978 Nov;131(5):823-5.
2. H J Swan, W Ganz, J Forrester, H Marcus, G Diamond, D Chonette. Catheterization of the Heart in Man With Use of a Flow-Directed Balloon-Tipped Catheter. N Engl J Med. 1970 Aug 27;283(9):447-51.
3. D T Kelly, J Krovetz, R D Rowe. Double-lumen Flotation Catheter for Use in Complex Congenital Cardiac Anomalies. Circulation. 1971 Nov;44(5):910-3.