Is there any role for simultaneous LV and RV angios?
Simultaneous LV and RV angios (left ventricular and right ventricular angiograms or ventriculograms) used to be done in hypertrophic cardiomyopathy (asymmetric septal hypertrophy) before the advent of echocardiography to delineate the interventricular septum. When both ventricles are opacified by iodinated radio contrast, interventricular septum will be seen as a negative shadow.
To take simultaneous LV and RV angios we will need:
- Dual vascular access (arterial and venous)
- Two angiographic catheters (one right ventricular angiographic catheter like NIH catheter and one left ventriculographic catheter like pig tail catheter)
- Two pressure injectors, one each to the arterial and venous catheters
- Simultaneous activation of both pressure injectors
In this era of echocardiography and computed CT angiography, invasive ventriculography is seldom done. This is because most of the information can be obtained in a better way non invasively without taking a catheter directly into the ventricles. CT angiography also enables three dimensional volume rendering which gives excellent spatial information. CT can be gated with ECG (electrocardiogram) to separate out systolic and diastolic frames.
A cardiac CT image of cardiac chambers delineating all four chambers and interventricular septum is available here (not a case of hypertrophic cardiomyopathy, but one illustrating left atrial thrombus).