Left heart ventricular angiography

Definition

Left heart ventricular angiography is a procedure to look at the left-sided heart chambers and the function of the left-sided valves. It is sometimes combined with coronary angiography.

Alternative Names

Angiography - left heart; Left ventriculography

How the Test is Performed

Before the test, you will be given medicine to help you relax. You will be awake and able to follow instructions during the test.

An intravenous line is placed in your arm. A cardiologist cleans and numbs an area on your arm or groin. Then the doctor makes a small cut in the area, and inserts a thin flexible tube (catheter) into an artery. Using x-rays as a guide, they carefully move the thin tube (catheter) into your heart.

When the tube is in place, dye is injected through it. The dye flows through the blood vessels, making them easier to see. X-rays are taken as the dye moves through the blood vessels. These x-ray pictures create a "movie" of the left ventricle as it contracts rhythmically.

The procedure will usually last less than one hour, but may take be considerably longer, especially if combined with other procedures.

How to Prepare for the Test

You will be told not to eat or drink for 6 to 8 hours before the test. The procedure takes place in the hospital or a specialized procedure unit. Some people may need to stay in the hospital the night before the test.

Your cardiologist will explain the procedure and its risks. You must sign a consent form for the procedure.

How the Test will Feel

You will feel a sting and burn when the local anesthetic is injected. You may feel pressure when the catheter is inserted. Occasionally, a flushing sensation or a feeling that you need to urinate occurs when the dye is injected.

Why the Test is Performed

Left heart angiography is performed to assess the blood flow through the left side of the heart.

Normal Results

A normal result shows normal blood flow through the left side of the heart. Blood volumes and pressures are also normal.

What Abnormal Results Mean

Abnormal results may be due to:

• A hole in the heart (ventricular septal defect) or other abnormal connections (congenital heart disease)
• Abnormalities of the left heart valves
• An aneurysm of the heart wall
• Areas of the heart that are not contracting normally
• Blood flow problems on the left side of the heart
• Heart-related blockages
• Weakened pumping function of the left ventricle

Coronary angiography may be needed when blockage of the coronary arteries or other coronary abnormalities is suspected.

Risks

Risks associated with this procedure include:

• Abnormal heartbeats (arrhythmias)
• Allergic reaction to dye or sedating medicines
• Artery or vein damage
• Cardiac tamponade
• Embolism from blood clots at the tip of the catheter
• Heart failure due to the volume of the dye
• Infection
• Kidney failure from the dye
• Low blood pressure
• Heart attack
• Hemorrhage
• Stroke

Considerations

Right heart catheterization may be combined with this procedure.

Left heart ventricular angiography has some risk because it is an invasive procedure. Other imaging techniques may carry less risk, such as:

• CT scans
• Echocardiography
• Magnetic resonance imaging (MRI) of the heart
• Radionuclide ventriculography

Your cardiologist may decide to perform one of these procedures instead of left heart ventricular angiography.

References

Kern MJ, Seto AH, Herrmann J. Invasive hemodynamic diagnosis of cardiac disease. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 22.

Valente AM, Dorfman AL, Babu-Narayan SV, Krieger EV. Congenital heart disease in the adolescent and adult. In: Libby P, Bonow RO, Mann DL, Tomaselli GF, Bhatt DL, Solomon SD, eds. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 12th ed. Philadelphia, PA: Elsevier; 2022:chap 82.

Virani SS, Newby LK, Arnold SV, et al. 2023 AHA/ACC/ACCP/ASPC/NLA/PCNA guideline for the management of patients with chronic coronary disease: A report of the American Heart Association/American College of Cardiology Joint Committee on Clinical Practice Guidelines. J Am Coll Cardiol. 2023;82(9):833-955. PMID: 37471501 www.ncbi.nlm.nih.gov/pubmed/37471501/.