[Improved cineangiographic evaluation of hypertrophic cardiomyopathy by biventriculography with angled projection]

Abstract

Left ventricular cineangiography with angled projection has been designed to overcome limitations of conventional angiography in the diagnosis of various heart diseases. Thus, to delineate the precise extent and degree of the thickness of the ventricular septum and left ventricular free wall in patients with hypertrophic cardiomyopathy, we performed biventriculography with angled projection (angled BVG) in 14 patients with hypertrophic cardiomyopathy (HCM), three with concentric hypertrophy and one with dilated cardiomyopathy. We also performed conventional biventriculography (nonangled BVG) in 9 of these 18 patients. The length of the interventricular septum (LIVS) and the long axis of the left ventricular cavity (LLV) measured by angled BVG (LIVS = 8.07 +/- 1.41 cm and LLV = 9.10 +/- 1.36 cm, n = 9) were significantly longer than those by nonangled BVG (LIVS = 5.88 +/- 1.17 and LLV = 7.15 +/- 1.24, n = 9) (p less than 0.001). In addition, the mitral valve and ventricular septum were visualized more clearly. Systolic anterior motion of the anterior leaflet of the mitral valve was readily identifiable, which was not detected usually by the nonangled method. In summary, angled BVG afforded increased precision in evaluation of the interventricular septum, left ventricular outflow tract and mitral valve in patients with HCM because these structures are seen in profile, an anatomy of the interventricular septum and an abnormal motion of the mitral valve can be better evaluated. Thus, angled BVG is the diagnostic procedure of choice in patients suggestive of hypertrophic cardiomyopathy.