Ventriculography Using ECG-Gated Multiple Diastolic Injection of Contrast Material in Pediatric Angiocardiography

In pediatric patients, the lower body weight limits the volume of contrast medium. Conventionally, angiocardiography is carried out with a single large bolus injection of contrast material. Angiocardiograms are used in pediatric patients with complex congenital heart diseases. In patients with complex congenital heart disease, especially with MAPCA, the volume of contrast medium used may be excessive. This would allow further injection to provide additional information. To reduce contrast medium used in the angiocardiogram in pediatric patients, we decided to use electrocardiogram (ECG)-gated multiple diastolic injection (EMDI). Three small boluses were injected during the diastolic phase of three consecutive cardiac cycles using a commercially-available power injector. Seventy-eight ventriculograms (47 left ventriculograms and 31 right ventriculograms) using EMDI were carried out on 53 patients with congenital heart disease. Total contrast medium volume with EMDI ventriculograms (mean [±SD] per body weight: 0.72 [±0.25] ml/kg) was significantly smaller than with conventional injection (1.01 [±0.36] ml/kg) (p <0.001). The grades of ventriculograms with EMDI tended to be slightly better than those with conventional injection (statistically not significant, p = 0.478). No short-run type premature ventricular contraction (PVC)s or intramural injection occurred in the ventriculograms with EMDI. PVCs tended to be less frequent in the ventriculograms with EMDI than in those with conventional injection (statistically not significant, p = 0.131). EMDI may be worthwhile in reducing ventricular ectopy when checking ventricular function by angiography, since hemodynamic conditions are less affected by small quantities of contrast medium and only during the filling phase of the ventricles. In conclusion, EMDI may be a useful method for reducing complications of ventriculography in pediatric angiocardiography.