Cardiovascular angiography

Cardiovascular angiography is one of the important means of diagnosing cardiovascular disease. It is a relatively complicated special inspection method, which has certain risks and needs to be strictly controlled. 1. Right heart angiography (1) Congenital heart disease is diagnosed before surgery. (2) Determine the nature of the heart murmur to guide treatment. (3) Symptoms reappear after heart surgery and need to be operated again. 2. Left heart angiography (1) mitral stenosis or regurgitation. (2) Aortic stenosis or regurgitation. (3) Congenital heart disease. (4) Primary cardiomyopathy. (5) left ventricular ventricular aneurysm and the like. Basic Information Specialist classification: cardiovascular examination classification: X-ray Applicable gender: whether men and women apply fasting: fasting Tips: Fasting 3 to 4 hours before the test. Seriously practise the actions that the doctor has to do in the examinations, such as inhaling and closing the air, to cooperate with the inspection. Normal value Normal cardiovascular. Clinical significance Can be used for the diagnosis of cardiovascular diseases: Right heart angiography (1) Congenital heart disease is diagnosed before surgery. (2) Determine the nature of the heart murmur to guide treatment. (3) Symptoms reappear after heart surgery and need to be operated again. 2. Left heart angiography (1) mitral stenosis or regurgitation. (2) Aortic stenosis or regurgitation. (3) Congenital heart disease. (4) Primary cardiomyopathy. (5) left ventricular ventricular aneurysm and the like. 3. Coronary angiography (1) severe angina pectoris or recurrent angina after myocardial infarction. (2) Review after coronary artery bypass grafting. (3) Congenital malformations of the coronary arteries. (4) Clinically suspected coronary heart disease, but the symptoms are not typical. Precautions Fasting 3 to 4 hours before the test. Seriously practise the actions that the doctor has to do in the examinations, such as inhaling and closing the air, to cooperate with the inspection. Inspection process Right heart selective angiography (1) The method of puncture of the femoral vein and delivery of the contrast catheter is the same as that of the right heart catheter or after the right heart catheterization. (2) The location and clinical significance of the injection of contrast agent: 1 Near the right entrance: the right atrium is used for the diagnosis of right atrial myxoma or right atrial thrombus. If the contrast agent flows back into the pulmonary vein of the malformed drainage, it can be confirmed. 2 right atrium: for the diagnosis of right atrioventricular valvular deformity, right atrioventricular stenosis or atresia. 3 right room: development of the right ventricle, right ventricular outflow tract, pulmonary valve and pulmonary artery trunk. Used to understand the diagnosis of pulmonary stenosis type and tetralogy of Fallot and some ventricular septal defect (combined right to left shunt). 4 pulmonary artery: can show pulmonary artery dilatation, peripheral pulmonary artery stenosis and pulmonary arteriovenous fistula. (3) Before injecting the contrast agent, it must be confirmed that the catheter tip is free in the heart chamber or the lumen of the blood vessel. (4) Extraction of the catheter 1 After the examination, use 5ml spare syringe to pump arterial blood 1 ~ 2ml to check blood oxygen, pull out the venous sheath, partial compression for 5 ~ 10min, pressure bandage, flat car returned to the ward. 2 postoperative supine 6h, antibiotics 3d to prevent infection, pay attention to puncture site bleeding and hematoma and dorsal artery pulsation. 2. Left heart selective angiography (1) Femoral artery puncture and feeding into pigtail catheter 1 arterial selection: more choice of right femoral artery, if necessary, left femoral artery and radial artery. 2 arterial puncture: 2 cm below the midpoint of the right inguinal ligament, the strongest point of the femoral artery beat as the puncture point. Anesthesia and local incision methods are the same as venipuncture. The left hand 2, 3, 4 finger touches the femoral artery, the right thumb and index finger hold the needle tail (the needle tip section is upward), and the skin is slowly infiltrated with the skin from 45° to 60° in the direction of reverse blood flow. When the pulse is felt, the deep is further Puncture a little, at this time a large amount of arterial blood is ejected, indicating that the needle tip is in the arterial cavity, and finally the J-shaped guide wire and the dilatation sheath are delivered along the puncture needle in the same manner as the venipuncture. 3 Feeding the catheter: Take a suitable pigtail tube and insert a long J-shaped wire soft head (1.46~2.2m) into the pigtail nozzle. Then, the pigtail tube and the guide wire are sent into the arterial cavity along the arterial sheath, and then the guide wire is sent to 10-20 cm, so that the guide wire soft head is in front of the pigtail tube. Under X-ray fluoroscopy, the pigtail tube and the guide wire are sent to the left ventricle along the aorta, the guide wire is withdrawn, and 10 to 20 ml of heparin saline is injected into the pigtail tube. Connect the tail end of the pigtail tube to the three-way switch and the pressure measuring tube for pressure measurement. 4 Pressure measurement and blood sampling: pressure measurement and blood collection in the left ventricle and aorta, respectively. Continuous pressure measurement when the pigtail tube retreats to the aorta. 5 left angiography if necessary. After the operation, the pigtail tube was withdrawn, the arterial sheath was pulled out, and the local pressure was stopped for 20 to 30 minutes. The wide tape was pressure-wrapped and the sand bag was pressed for 6 hours. 6 postoperative supine for 24h, antibiotics 3d to prevent infection, pay attention to puncture site bleeding and hematoma and dorsal artery pulsation. (2) Select the site where the contrast agent is injected as needed 1 left ventricle: for left ventricular aneurysm, ventricular septal defect (left to right shunt), diagnosis of left atrioventricular valve insufficiency, and understanding of the type of aortic stenosis (upper, subvalvular or valve). 2 aorta: can be delivered to the ascending aorta, aortic arch, descending aorta or abdominal aorta as needed for the diagnosis of aortic sinus aneurysm rupture, aortic coarctation, aortic regurgitation and patent ductus arteriosus. (3) postoperative treatment 1 For patients with local compression and hemostasis, the puncture side limbs were braked for 10 to 24 hours, and the sandbags were pressed for 6 hours. The patient's symptoms, vital signs, electrocardiogram, puncture site and peripheral circulation were closely observed within 24 hours. 2 Encourage patients to drink water or intravenous rehydration to promote contrast agent excretion. Take care to correct electrolyte imbalances. Not suitable for the crowd Significant pulmonary hypertension, severe purpura, heart failure, iodine allergy or severe renal insufficiency are contraindicated. 1. Acute infection period: such as infective endocarditis, myocarditis, active rheumatism and suppurative infections. 2. Severe heart failure. 3. Severe arrhythmia, including ventricular tachycardia and high atrioventricular block (operating under the protection of an artificial cardiac pacemaker). 4. Severe bleeding tendency. Adverse reactions and risks There may be an allergic reaction such as iodine, infiltration of iodine contrast agent into the myocardium, perforation of the heart, and induction of renal failure.