RESUMO
Left ventriculography provides useful information about cardiac function, wall motion, and mitral regurgitation (MR). However, standard volumes of contrast agent frequently are associated with ventricular ectopy. This study compares the use of low-volume (Low-vol) ventriculography to standard volume (Std-vol) ventriculography. Left ventricular (LV) ejection fraction (EF), changes in LV end-diastolic pressure (LVEDP), the incidence of ectopy, and > 2+ MR were prospectively determined from the random order use of standard (15 mL/ second for 3 sec) and low-volume (15 mL/sec for 1 sec) contrast agents in 102 patients. Each patient served as his or her own control. Twenty-seven percent of the 204 ventriculograms were not interpretable due to ectopy. Ectopy > or = 3 beats was more common with Std-vol angiograms (41% vs. 14%, P < 0.001). Post-injection LVEDP increased from baseline after both Std-vol and Low-vol injections (P < 0.001). In patients for whom both angiograms could be interpreted (n = 58), no differences were noted between planimetered EFs (Low-vol = 61 +/- 20% vs. Std-vol = 62 +/- 20%, with r = 0.87; P < 0.001). A Bland-Altman test of agreement indicated a mean difference +/- 95% CI = -2 +/- 19%. Low-volume ventriculography reduces contrast load and ectopy while providing similar estimates of EF compared with standard volumes.
Assuntos
Doença das Coronárias/diagnóstico por imagem , Ventrículos do Coração/diagnóstico por imagem , Aumento da Imagem , Processamento de Imagem Assistida por Computador , Insuficiência da Valva Mitral/diagnóstico por imagem , Contração Miocárdica/fisiologia , Volume Sistólico/fisiologia , Função Ventricular Esquerda/fisiologia , Adulto , Idoso , Angiografia , Meios de Contraste/administração & dosagem , Doença das Coronárias/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/fisiopatologia , Valor Preditivo dos Testes , Complexos Ventriculares Prematuros/diagnóstico por imagem , Complexos Ventriculares Prematuros/fisiopatologiaRESUMO
We report a case of complete heart block (CHB) and polymorphic ventricular tachycardia (VT) which was associated with a modest-sized myocardial infarction (MI) following incidental occlusion of the first septal perforator (FSP) branch after stent deployment to the left anterior descending (LAD) coronary artery. These complications were successfully treated with temporary pacing and subsequently resolved with spontaneous recanalization of the first septal perforator. This case represents an interesting product of medical progress which defies the adverse natural history and poor prognosis of anteroseptal MI associated with CHB due to the small amount of myonecrosis associated with this event.