LV Ventriculography & Aortography

What it does

LV Ventriculography & Aortography reads the contrast runs of the left ventricle and the aortic root recorded during a left-heart catheterisation. These runs are usually reported together with the coronary arteries, and their LVEF and regurgitation grades are often estimated visually.

From the LV gram, the run traces the end-diastolic and end-systolic contours, computes ventricular volumes and the ejection fraction, grades wall motion segment by segment, and grades mitral regurgitation from contrast filling of the left atrium. From the aortogram, it grades aortic regurgitation, including paravalvular regurgitation after TAVI.

Intended use

Decision support for physicians reporting a left-heart cath: quantified LV function and regurgitation grades for the ventriculography section of the report. The 2021 ESC/EACTS valvular guideline reserves these runs for patients in whom non-invasive imaging is inconclusive.

Who it is for

Interventional and general cardiologists, cardiology fellows and structural-heart teams. Coronary Angiography recognises the LV-gram and aortogram runs in a whole cath study and routes them to this model.

Accepted input

• LV gram: one or more X-Ray Angiographic cine runs of the left ventricle (multi-frame XA or Enhanced XA, or a zip of single-frame instances).
• Aortogram: a cine run of the aortic root, before or after transcatheter valve implantation.
• Whole studies: a cath CD or study folder; ventriculography and aortography runs are picked out of the study.

Requirements per run

Requirement	Why
LV gram in RAO projection (about 30°)	Single-plane volumes and segment names assume the RAO view
At least one full cardiac cycle	End-diastolic and end-systolic frames are both needed
Pixel spacing with source distances (or a magnification factor)	Volumes in millilitres; without it, volumes are flagged as uncalibrated
Frame rate in the header	Cycle timing and contrast passage for the regurgitation grades
Not a rotational acquisition	The model reads fixed projections

Optional context

Rhythm at the time of the run, the valve under assessment and, after TAVI, the implanted valve type can be passed in clinical_context.

The result

One structured result per study, with contours, measurements and grades linked to the frames they came from.

Section	Content
LV volumes and LVEF	End-diastolic and end-systolic contours, volumes and ejection fraction
Regional wall motion	Each segment graded normal, hypokinetic, akinetic, dyskinetic or aneurysmal
Mitral regurgitation	Sellers grade 1–4 from left atrial opacification on the LV gram
Aortic regurgitation	Sellers grade 1–4 from the aortogram, with post-TAVI paravalvular regurgitation by videodensitometry
Draft report	Opt-in (options.report): an English narrative that interprets the result for the reader (findings, impression, limitations); every number is checked against the findings

Standards

• DICOM: findings follow TID 3814 Left Ventriculography Findings within the TID 3800 Cardiac Catheterization Report; measurements as SR TID 1500; contours as SEG; key frames as Secondary Capture.
• Volumes: single-plane area–length method (Sandler & Dodge, Am Heart J 1968).
• Regurgitation: Sellers grade (Am J Cardiol 1964) for mitral and aortic regurgitation; quantitative aortography for regurgitation after TAVI.

Grading notes

Sellers grades follow the contrast density of the receiving chamber relative to the injected one over the cardiac cycles of the run. Each grade links to the run and key frames it was read from, so the grade and the images are reviewed together.