2 English reference ACG
angiocardiography
Canada
China Architecture Design and Research Institute
angiocardiography
Cardiovascular imaging equipment
Contrast angiocardiography
Summarize that angiocardiography is a technique of rapidly injecting contrast agent into the heart cavity, so that the heart and great vessels can be developed under X-ray, and used for cardiovascular disease examination.
Name of operation: angiocardiography
5 Indications for angiocardiography are as follows:
1. Right heart selective angiocardiography? Pulmonary artery stenosis, tetralogy of Fallot, great vascular dislocation, pulmonary arteriovenous fistula, right atrioventricular valve disease and right atrial myxoma.
2. Left ventricular selective angiocardiography
(1) To understand ventricular septal defect and its associated malformations.
(2) To understand the degree of left atrioventricular valve insufficiency and left atrioventricular valve fissure.
(3) To understand the types of aortic stenosis.
(4) Understand the size and scope of ventricular aneurysm.
(5) Understand the degree of aortic valve insufficiency.
(6) Understand patent ductus arteriosus.
Contraindications: Pulmonary hypertension, severe cyanosis, heart failure, iodine allergy or severe renal insufficiency are contraindications.
1. Acute infection? Such as infective endocarditis, myocarditis, active rheumatism and purulent infection.
2. Severe heart failure.
3. Severe arrhythmia, including ventricular tachycardia and high atrioventricular block (which can be operated under the protection of artificial pacemaker).
4. Severe bleeding tendency.
7 prepare 1. Equipment and contrast media? In addition to the cardiac catheterization room equipment, the examination equipment of cardiovascular angiography also needs contrast agent and contrast catheter.
(1) Contrast agent: 60% ~ 76% meglumine diatrizoate, which is low in price and low in toxicity, is the most commonly used. Non-ionic contrast agents such as Youweixian can be used when renal insufficiency or iodine allergy occurs. The dose of contrast agent is generally 1.0ml/kg each time, about 40 ~ 50 ml for adults, and the injection speed of contrast agent is15 ~ 21ml/s.
(2) Contrast cardiac catheter: There is an end hole and two side holes at the top of the right cardiac contrast catheter for contrast of the right cardiac system. There is an end hole and more than ten side holes at the top of the pig tail tube, which is mainly used for left cardiac angiography and occasionally for right cardiac angiography.
2. Iodine allergy test must be done for preoperative selective right heart and left heart angiocardiography. Skin preparation was made in bilateral groin area 1 day before operation, and penicillin iodine allergy test (diazepam) 5mg was done before going to bed. Fasting on the morning of operation, giving 5% ~ 10% glucose solution to the back of left foot.
Method 8. 1. 1. Right heart selective angiocardiography (1) punctured femoral vein, followed by right heart catheter method or right heart catheter method, and then sent contrast agent catheter.
(2) The location of injected contrast agent and its clinical significance:
① Near the entrance of the right atrium: develop the right atrium for the diagnosis of myxoma or thrombus in the right atrium. If the contrast agent returns to the abnormally drained pulmonary vein, its existence can be confirmed.
② Right atrium: It is used to diagnose right atrioventricular valve displacement, right atrioventricular valve stenosis or atresia.
③ Right ventricle: right ventricle, right ventricular outflow tract, pulmonary valve and pulmonary trunk are well developed. It is used to understand the types of pulmonary artery stenosis and the diagnosis of tetralogy of Fallot and partial ventricular septal defect (with right-to-left shunt).
④ Intra-pulmonary artery: Pulmonary artery dilatation, peripheral pulmonary artery stenosis and pulmonary arteriovenous fistula can be displayed.
(3) Before injection of contrast agent, it must be confirmed that the catheter tip is separated from the heart cavity or vascular cavity.
(4) Remove the catheter after operation.
① After the examination, use 5ml spare syringe to draw femoral blood 1 ~ 2ml to check blood oxygen, pull out venous sheath, locally pressurize it for 5 ~ 10 min, and transport it back to the ward.
② After operation, lie on your back for 6 hours and apply antibiotics for 3 days to prevent infection, and pay attention to bleeding, hematoma and pulse of dorsal artery of foot at puncture site.
8.2 2. Left heart selective angiocardiography (1) femoral artery puncture and pigtail catheter delivery method
① Arterial selection: choose multiple right femoral arteries, and if necessary, choose left femoral artery and brachial artery.
② Arterial puncture: the puncture point is 2cm below the midpoint of the right inguinal ligament, and the femoral artery has the strongest pulsation. Anesthesia and local incision are the same as venipuncture. Touch the femoral artery with the fingers of the left hand 2, 3 and 4, hold the needle tail with the thumb and forefinger of the right hand (the outline of the needle tip is upward), and slowly pierce the skin at 45 ~ 60 degrees along the blood flow direction. When you feel the pulse, you will puncture deeper, and at this time, a large amount of arterial blood will be ejected, indicating that the needle tip is in the arterial cavity, and finally it will be sent into the J-shaped guide wire and expansion sheath along the puncture needle. Methods Same as venipuncture.
③ Feeding tube: Take a suitable pigtail tube and insert a long J-shaped guide wire soft head (1.46 ~ 2.2m) into the pigtail nozzle in advance. Then the pigtail tube and the guide wire are sent to the arterial cavity along the arterial sheath, and then the guide wire is sent to 10 ~ 20 cm, so that the soft end of the guide wire is in front of the pigtail tube. Under X-ray fluoroscopy, the pig tail tube and guide wire were sent to the left ventricle along the aorta, the guide wire was pulled out, and heparin saline 10 ~ 20 ml was injected into the pig tail tube. Connect the tail end of pigtail pipe with three-way switch and manometer to measure the pressure.
④ Pressure measurement and blood collection: Pressure measurement and blood collection were carried out in the left ventricle and aorta respectively. Continuous pressure measurement when pig tail tube retreats to aorta.
⑤ Left angiocardiography was performed when necessary. After operation, the pig tail tube was removed, the arterial sheath was pulled out, and the bleeding was stopped by local compression for 20 ~ 30 min. The wide adhesive tape was pressed and bandaged, and sandbags were pressed for 6 hours.
⑥ Lie on your back 24 hours after operation, use antibiotics for 3 days to prevent infection, and pay attention to bleeding, hematoma and pulse of dorsal artery of foot at puncture site.
(2) Select the site where the contrast agent is injected as required.
① Left ventricle: It is used to diagnose left ventricular aneurysm, ventricular septal defect (left-to-right shunt) and left atrioventricular valve insufficiency, and to understand the types of aortic valve stenosis (supravalvular, subvalvular or subvalvular).
② Aorta: It can be sent to ascending aorta, aortic arch, descending aorta or abdominal aorta according to the needs of diagnosing sinus aneurysm rupture, aortic coarctation, aortic valve insufficiency and patent ductus arteriosus.
(3) postoperative treatment
① Local compression of hemostasis patients, limb immobilization at puncture side 10 ~ 24h, sandbag compression for 6h. Observe the symptoms, vital signs, electrocardiogram, puncture site and peripheral circulation of the patient within 24 hours.
② Encourage patients to drink water or intravenous infusion to promote the excretion of contrast media. Pay attention to correct electrolyte disorder.
9 preventive measures