To help understand the following left ventriculogram from a normal patient, a diagram of the left heart is shown in the right anterior oblique view. The left atrium, left ventricle, and aorta are labeled. The tip of the pigtail catheter is positioned in the left ventricle. The motion of the left ventricle from diastole to systole is also indicated by the arrows.
Right anterior oblique left ventriculogram
This is a right anterior oblique left ventriculogram from our patient. Note the tip of the pigtail catheter in the left ventricle. Contrast material has been injected into the left ventricle and is seen in the left ventricle, aorta, and is a normal result of ventricular ejection, also in the markedly enlarged left atrium, reflecting significant mitral regurgitation.
In the real-time study that follows, note the walls of the left ventricle move well. All of these findings are particularly well seen in the slow-motion sequence that follows the real-time study.
Left ventricular and pulmonary capillary wedge pressure tracings
These are the simultaneous left ventricular and pulmonary capillary wedge pressure tracings of our patient. The latter pressure is obtained by wedging the catheter into a distal pulmonary artery, and reflects left atrial pressure. A large regurgitant “v” wave is clearly shown. It peaks at 22 mmHg, and reflects significant mitral regurgitation. A gradient across the mitral valve is present only in early and mid diastole. This does not imply concurrent mitral stenosis, as increased flow alone may cause this type of gradient in patients with severe isolated mitral regurgitation.
Note also the mild elevation of pulmonary artery mean pressure, reflecting mild pulmonary hypertension, and the reduced cardiac index, reflecting a decrease in output. In addition, the patient’s coronary arteries were angiographically normal.