Assessment Of Cardiovascular Dynamics

The chest roentgenogram that is taken at random largely records the diastolic image of the heart. Fluoroscopy, on the other hand, provides a continuous vision of the pulsating organ through the entire cardiac cycle. On becoming familiar with the normal cardiovascular movements, the fluoroscopist will find that any deviation from the norm will be obvious.2,29-32

The telltale x-ray signs of many cardiac lesions manifest themselves only in ventricular systole. Therefore, what may be missed on the film is often readily seen and diagnosed under the fluoroscope. For instance, left ventricular enlargement may be the only radiographic abnormality of severe aortic regurgitation in children or young adults. On fluoroscopy, however, the aorta is vigorously expanding in systole and rapidly collapsing in diastole. This dynamic alternation is characteristic of aortic regurgitation (Fig. 12-24). Other examples include mild mitral regurgitation, mitral valve prolapse, left ventricular dyskinesia, and broad-based left ventricular aneurysm.

Coronary Artery Fluoroscopy
Figure 12-24: Schematic representation of dynamic changes of aortic regurgitation. Blue interrupted lines represent images in systole; solid lines, those in diastole.

In valvular pulmonary stenosis, vigorous pulsation of the pulmonary trunk and its left branch is in bold contrast to the diminished pulsation of the right pulmonary artery.31 Increased pulsation of diffusely enlarged pulmonary arteries is characteristic of left-to-right shunts. When marked discrepancy in size and pulsation is noted between the central and peripheral vessels, Eisenmenger's syndrome should be considered. Exaggerated left atrial expansion in ventricular systole is a reliable sign of mitral regurgitation.32

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