Guided Coronary Arteriography and Left Ventriculography

Selective coronary arteriography is accepted by most angiographers as the technic of choice for the reliable demonstration of the coronary arterial system. Previously we reported the use of a percutaneous transaxillary application of the Sones technic (6) which we have now modified even further by use of a tip-deflecting system. The technic and results of guided coronary arteriography will be reported below. In addition, the advantages of a combined approach of coronary arteriography with left heart catheterization and left ventriculography for a more complete evaluation of coronary artery disease will be emphasized. Instrumentation and Technics A modification of the Muller-USCI deflector guide system is utilized. Unfortunately, the catheter supplied with this guide system has the disadvantage of poor delivery time of contrast agent, preventing satisfactory use of the catheter with the guide wires maintained in position. A thin-walled polyethylene catheter has therefore been designed for use with the Muller guide; this allows a more adequate delivery time because of a larger inner diameter. Thin-walled polyethylene tubing with a special 20 per cent barium load is employed, either RPX 062-H which has an inner diameter of 0.062 inch and an outer diameter of 0.083 inch or the RPX 071-H which has an inner diameter of 0.071 inch and an outer diameter of 0.093 inch (Fig. 1). The catheters are 60 cm long. The distal 5 cm is tapered to approximately 5F, by drawing the catheter tip through the 18-gauge hole of a Joubert French Draw Plate Model D. Heating the plate prior to drawing the catheter facilitates the procedure. The inner diameter of the tip which has been reduced too much in the process is then dilated slightly by passing a rigid 0.050-inch wire through it while it is bathed in hot water. The catheter is flared at the large end and tapered to the wire to be used for percutaneous entry at the other end. Three side-holes the size of a 21-gauge needle are placed within 1.5) cm of the tip. The tip-deflecting wire will tend to exit through the side-holes if they are too large. After percutaneous puncture of the right axillary artery, a No. 5 or No. 6F Teflon catheter is passed over the wire approximately 5 cm into the artery for dilatation, to facilitate introduction of the polyethylene catheter. After placement of the polyethylene catheter in the ascending aorta, the Muller guide system with a 60-cm, 0.035-inch tip-deflecting wire is introduced into the catheter, and, by controlling the deflectable guide, the angle of the catheter may be varied so that each coronary artery may be selectively catheterized. An important attribute of the system is the ability to “pay out” the catheter over the tip of the wire in order to obtain a more suitable position in relationship to the ostium of the coronary artery and also to feed the catheter into the coronary artery (Fig. 1).