11 Angiography of the Pulmonary Artery
Specific Indications and Contraindications
The most common indication for pulmonary angiography is acute pulmonary embolism. Other indications are
Primary pulmonary arterial hypertension
Arteriovenous fistulas of the pulmonary vessels
Congenital anomalies such as anomalous drainage of the pulmonary veins
Imaging of the left heart, of the atrium, and of the ventricle with continued recording
Tumor infiltration of the pulmonary vessels before surgery
Imaging prior to angioplasty and/or stenting of pulmonary vessels
Particular caution is warranted in patients with advanced pulmonary arterial hypertension (systolic pulmonary artery pressure > 60 mm Hg). The acute volume load due to contrast medium administration can lead to right heart decompensation.
Otherwise, the same precautions and potential complications apply as with right heart catheterization.
Acute pulmonary embolism represents a special situation, as with this life-threatening condition all contraindications are relative and rapid angiographic diagnosis and subsequent therapy are of overriding importance.
Procedure
Catheter
Balloon angiography catheters (Berman) size 6F or 7F and pigtail catheters size 5F to 7F are suitable. The catheters have to allow relatively high injection rates and have to be stiff enough to withstand the recoil during injection.
Procedure
Venous puncture.
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