Superselective Left Atrial Cineangiocardiography

A study of selective left atrial cineangiographic technique was undertaken to determine the diagnostic value and practicality of ECG-triggered intermittent systolic injections. One hundred intermittent systolic injections were performed in 83 infants, children and adults with mitral valvular lesions or congenital defects in the atrial or ventricular septum. A Contrac injector with short pressure rise time enabled rapid delivery of pre-selected flow rates and appropriate contrast volumes into the left atrium during one or repeated ventricular systolic periods. Systolic injection technique provides superior visualization of left atrial size and morphology with small injection volumes. There is superior visualization of left atrial outflow through the mitral valve or atrial septal defects due to accumulation of higher contrast gradients during the systolic atrial filling period. Better anatomic detail of contrast jet size and direction as well as more physiologic filling and washout of the atrium is obtained. Timeselective as well as anatomically selective injection technique results in significantly lower contrast volumes and a resultant increase in patient safety particularly important in pediatric patients with complicated congenital heart lesions.