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Percutaneous fiberoptic cardioscopy of the left ventricle
Y Uchida1, T Tomaru, F Nakamura
1Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Insights
Percutaneous transluminal cardioscopy using a guiding balloon catheter is a safe and feasible method for detailed left ventricular endocardial imaging. This technique provides clear visualization of the heart
Area of Science:
- Cardiology
- Medical Imaging
- Minimally Invasive Procedures
Background:
- Assessing left ventricular endocardial detail is crucial for diagnosing various heart conditions.
- Traditional methods may lack the resolution needed for subtle endocardial changes.
Purpose of the Study:
- To evaluate the feasibility and safety of percutaneous transluminal cardioscopy of the left ventricle.
- To assess the diagnostic value of this technique in patients with and without heart disease.
Main Methods:
- A guiding balloon catheter was inserted via the femoral artery into the left ventricle in 35 patients.
- A fiberscope was advanced, and heparinized saline was infused to visualize the endocardium.
- Images were recorded using videotape and 16 mm cinefilm.
Main Results:
- The procedure was feasible and safe, with only transient ventricular arrhythmias noted.
- Detailed endocardial images were obtained, revealing characteristic findings in patients with dilated cardiomyopathy, myocarditis, mitral stenosis, and prior infarctions.
- Normal endocardium appeared brown with prominent systolic trabeculae.
Conclusions:
- Percutaneous fiberscopic imaging with a guiding balloon catheter is a safe and feasible diagnostic tool.
- This technique provides highly detailed visualization of the left ventricular endocardium.
- It holds potential for improved diagnosis of various cardiac pathologies.
Abstract:
The feasibility of percutaneous transluminal cardioscopy of the left ventricle was examined in 35 patients with or without various heart diseases. A guiding balloon catheter (7 or 9 French) was introduced through the right femoral artery into the left ventricle. The balloon was inflated, and a fiberscope (1.6 or 4.3 French) was advanced to the distal tip of the catheter. The balloon was then manipulated against the portion of the ventricle targeted for examination, and heparinized saline (10 U/ml) at body temperature was infused through the catheter at 5 ml/sec for 3 to 6 sec. The images were recorded on videotape and 16 mm cinefilm. In 4 patients without demonstrable heart disease, the endocardial surface of the left ventricle was brown and the trabeculae became prominent during systole. The chordae connected to the mitral leaflets were white. In 3 of 5 patients with dilated cardiomyopathy, the endocardium was light yellow with thin trabeculae which barely contracted during systole. The endocardium was red or reddish-brown in 3 patients with acute myocarditis. In patients with rheumatic mitral stenosis white patches were scattered on the endocardial surface. In 7 of 8 patients the akinetic or dyskinetic segments representing prior infarctions were white. No complications other than transient ventricular arrhythmias were noted. We conclude that percutaneous fiberscopic imaging with a guiding balloon catheter is feasible and safe, and yields highly detailed images of the endocardium.