Thoracic aortography in adults--technical aspects.

Abstract

My contribution to this symposium deals with the technical aspects of thoracic aortography—mainly in adults. A glance at the indications for thoracic aortography (Table I) will show that no one method is applicable for every examination and that variations in technique are necessary. The methods of examination may be considered under the two main headings of either indirect or direct aortography. The indirect methods rely on aortic contrast opacification either from the right or left side of the heart; from the right by venous angiocardiography (Steinberg and Dotter, 1949) or by injection of contrast medium through a cardiac catheter from the pulmonary artery (Jönsson, 1953); and from the left by left ventricular needle puncture (Lehman, Musser and Lykens, 1957) or transaortic left ventricular catherterisation (Hanson, Jönsson and Karnell, 1959). Angiocardiographic methods, whilst being relatively simple, have disadvantages, amongst the most important of which are the large volume of contrast medium required and the possibility of its dilution before adequate aortic opacification has been achieved, particularly in large hearts. Correct timing of films for optimum aortic opacification may, in spite of circulation time estimations, prove to be inaccurate. Moreover, a general anaesthetic is often required, involving a further hazard to the patient, and thus turning a relatively minor procedure into a major one.