Quantitation of Aortic Valvular Insufficiency by Catheter Thoracic Aortography

Abstract

Aortic valvular insufficiency is, with few exceptions, a consequence of rheumatic endocarditis or syphilitic aortitis. Rheumatic involvement of the aortic valve may produce varying degrees of stenosis or valvular insufficiency, either alone or in combination. The advent of surgical methods for treatment of rheumatic aortic valvular lesions has increased the importance of radiological study of the valve, determination of the extent and character of its pathological changes, and the degree of its functional impairment. While roentgen visualization of the aortic valve can be achieved by angiocardiography, provided a good “levo” study is obtained, or by cardiac ventriculography with introduction of a radiopaque medium by either transthoracic needle puncture or transaortic catheterization of the left ventricle, the most satisfactory method for radiologic study is catheter thoracic aortography. The procedure of catheter thoracic aortography was introduced in 1948 by Radner (1), who inserted a catheter into the right radial artery, advancing it to the ascending aorta. That same year, Broden et al. (2) reported on the use of Radner's technic in the study of coarctation of the aorta and of patent ductus arteriosus. In 1953, Seldinger (3) described a percutaneous method of catheter introduction for aortography. Ödman and Philipson (4) in 1958 published an account of their experience with catheter thoracic aortography, describing the appearance of the aortic valve in both aortic stenosis and aortic insufficiency in a series of 21 patients. They specifically stated that regurgitation phenomena in the left ventricle and other aortographic findings supply information regarding the severity of hemodynamic alterations in aortic valvular insufficiency. Three indices for estimating the degree of insufficiency were emphasized by these investigators: the rapidity of reflux filling of the left ventricle with the injected radiopaque agent; the length of time the ventricle and aorta remain opacified; the degree of dilatation and emptying capacity of the left ventricle. Methods, Materials, and Technic The present report deals with 273 examinations performed during the past three years. Catheter introduction in all patients was by cut-down exposure of the selected peripheral artery and arteriotomy. We have excluded all examinations in which a percutaneous catheter introduction technic (Seldinger procedure) was employed, a method we have adapted only recently to selected cases. Continuous electrocardiographic monitoring is standard procedure in every patient. Manometric pressure determinations were obtained whenever intentful transaortic catheterization of the left ventricle was part of the study. Equipment and medications for treatment and control of any complications incident to the catheterization and radiopaque injection are constantly at hand, as well as the necessary apparatus for cardiac resuscitation in the event of cardiac arrest or ventricular fibrillation.