Hepatoclavicular view for left ventriculography

Hepatoclavicular view for left ventriculography

Abstract: LAO (left anterior oblique) 40 degrees with 40 degrees cranial angulation is known as hepato clavicular view. It is used to profile inlet ventricular septal defects. 

Hepatoclavicular view for left ventriculography with forty degree left anterior oblique and forty degree cranial angulation is used for visualizing the inlet ventricular septum. It is thus needed to see atrioventricular septal defects (endocardial cushion defects) and posterior muscular ventricular septal defects. This view has more cranial angulation and less lateral angulation than a conventional left anterior oblique (LAO) view. LAO view for aortography to assess aortic arch and aortic regurgitation for example is performed at sixty degree LAO angulation. In the earlier era when the image intensifiers could not be rotated in multiple planes, the patient’s position was changed using plastic foam wedges to get the appropriate views.1 The hepato clavicular view gives a four chamber view of the heart. This view profiles the interatrial and interventricular septa and separates the atrioventricular valves. The cleft of anterior mitral leaflet in atrioventricular canal defects can be seen in this view. The hepato-clavicular view is useful in clarifying the relationship between the mitral valve and the semilunar valve and the outflow tract. But the outflow tract is better visualised in the long axial oblique view.

Visualizing the atrial septum

Hepatoclavicular view is also useful for visualizing atrial septal defects by injecting the proximal portion of the right upper pulmonary vein using the catheter tip. Contrast streams along the atrial septum to the mitral valve so that atrial septal defects anywhere along the septum can be visualized well. Unlike this injection, if you inject into the body of the left atrium, this streaming effect is not seen and the septal wall may not be well outlined.

References

  1. Bargeron LM Jr, Elliott LP, Soto B, Bream PR, Curry GC. Axial cineangiography in congenital heart disease. Section I. Concept, technical and anatomic considerations. Circulation. 1977 Dec;56(6):1075-83.