Related Experiment Videos
Percutaneous left ventricular angiography
Insights
Transapical left ventriculography offers a vital diagnostic method for heart failure patients post-valve replacement when other tests fail. This technique aids in distinguishing poor heart function from other issues, guiding surgical decisions.
Area of Science:
- Cardiology
- Interventional Cardiology
- Cardiac Surgery
Background:
- Diagnosing persistent heart failure after mitral and aortic valve replacement is challenging.
- Noninvasive tests and standard cardiac catheterization may not differentiate poor left ventricular function from paraprosthetic leak or pulmonary vascular disease.
- Left ventricular inaccessibility complicates diagnostic evaluations.
Purpose of the Study:
- To evaluate the utility of transapical left ventriculography in diagnosing heart failure post-valve replacement.
- To assess the safety and efficacy of percutaneous transapical flexible angiographic catheter passage in this patient group.
Main Methods:
- Left ventriculography was performed via direct transapical puncture using a flexible angiographic catheter.
- The procedure was conducted in 15 patients (16 occasions) with suspected persistent heart failure after valve replacement.
- Clinical decisions were made based on the diagnostic information obtained.
Main Results:
- Transapical left ventriculography provided crucial diagnostic information in challenging cases.
- Non-fatal complications occurred in three patients.
- The procedure successfully distinguished operable from inoperable patients, enabling appropriate clinical management.
Conclusions:
- Percutaneous transapical left ventriculography is a valuable alternative diagnostic tool when standard methods are insufficient.
- This technique aids in guiding surgical decisions for patients with persistent heart failure after valve replacement.
- The procedure demonstrated a favorable risk-benefit profile in this cohort.
Abstract:
Recurrence of persistence of heart failure in patients after mitral and aortic valve replacement is a difficult diagnostic problem. Clinical evaluation and noninvasive tests cannot always distinguish poor left ventricular function from paraprosthetic leak or persistent pulmonary vascular disease. Full evaluation by cardiac catheterisation may then be necessary but is difficult because of the inaccessibility of the left ventricle. Under these circumstances, left ventriculography by direct transapical puncture is an alternative to crossing the prosthesis by a catheter and may be the only way of obtaining diagnostic information. We describe our experience of left ventriculography by percutaneous transapical passage of a flexible angiographic catheter (as distinct from a rigid angiographic needle) in 15 such patients (on 16 occasions). Non-fatal complications occurred in three patients. The information thus obtained allowed a clinical decision to be made and distinguished the inoperable from the operable group. Surgery was subsequently performed in seven patients with beneficial results.