3DRA protocol

General rule: Inject into chamber or vessel proximal to area of interest.
All injections are over 5 secs. (4 sec acquisition starts after 1 sec delay to allow for uniform opacification from the beginning of image acquisistion)
Contrast: Isoview

Great arteries: (Aorta, PA, RV-PA conduits)
    (i) Contrast:Saline dilution = 2:1
    (ii) Total volume of injection: 3 ml/kg over 5 seconds
    (iii) Generally, need to inject prior to segment of interest. May inject in MPA or aortic root for distal vessels

Central systemic veins: (SVC, IVC)
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 0.75 - 1.5 ml/kg
   (iii) Inject into proximal vein

Glenn anastamosis & Branch PAs:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg
   (iii) Inject into high SVC or Innominate vein
   (iv) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Fontan:
   (i) Contrast:Saline dilution = 2:1
   (ii) Total volume of injection: 1.5 ml/kg (Divided for simultaneous SVC/IVC injections. Usually, 50/50. But, this may vary based on flow characteristics of SVC/IVC flow into each branch PAs).
   (iii) Note: Wash-out from A-P collateral flow into branch PA may interfere with 3D reconstruction.

Pulmonary veins:
   (i) Undiluted contrast
   (ii) Total volume of injection: Varies depending upon vein size, degree of stenosis, collateralization, etc.
   (iii) Inject as PA wedge angiogram. Begin injection, but wait until contrast appears in pulmonary veins before initation of rotation.

Selective Coronary Artery:
   (i) Undiluted contrast
   (ii) Total volume of injection: Inject enough to opacify vessel during the entire acquisition. Amount varies based on vessel size, stenosis, etc.

Surgical shunts (e.g. BT shunt):
   (i) Undiluted contrast
   (ii) Total volume of contrast: Enough to opacify the vessels during the entire acquisition. Amount varies depending on anatomy.
   (iii) Inject using a end-hole catheter with proximal balloon occlusion (if possible)

(Adapted from Denver Children's Hospital Protocol. Courtesy: Dr. Tom Fagan).


 

Gradient measurement difference between echo vs. cath (Aortic Stenosis)

LV and Ascending Aorta pressure traces are provided below.

From J.T.Bricker & D.G. McNamara Paediatric Cardiology: Its current practice. Edward Arnold, London 1988. Page 45.

EKG: Dextrocardia

Panel 1: EKG recorded with standard lead placements
Panel 2: EKG recorded with reversed lead placement (Illustrates why this should not be done)

It is good exercise to compare the two EKGs and identify how reversing lead positions change the morphology of the complexes.

Fluoroscopically-guided Femoral Artery Access (Adult)

J Invasive Cardiology April 2011;23:156-161