Method of recording sequential X-ray images of the heart and great arteries after

the selective injection of iodinated contrast medium. It is used to evaluate

morphology, dimensions and function of the heart and morphology of the great
arteries. Cineangiography has for decades served as the definitive technique for
demonstrating the morphology of congenital heart disease. Cineangiography after
selective injection of contrast media in the coronary arteries (coronary
arteriography) is the imaging modality employed for defining coronary arterial
anatomy and pathology.

Cineangiography employs a cine camera to record the images from the image
intensifier onto cine film. Cardiac cineangiography is typically performed at 30
frames per second. Coronary angiography is typically performed at around 60
frames per second. Cardiac cineangiography is performed in either the single plane
or biplane modes. The biplane mode is used for cardiac cineangiography in children
and sometimes also in adults. The single plane mode is used for coronary
cineangiography. In addition to recording of images on cine film as the primary
archival medium, images may also be simultaneously recorded on analogue
videotape or analogue optical disk for immediate viewing. Analogue videotaping of
cardiac images is largely being replaced by digital recording media.

In recent years cardiac angiography and coronary angiography have been moving
to the utilization of digital acquisition and display of sequential images. With digital
recording of images, there is immediate conversion of image data into numbers,
storage of the numbers and the option of computer manipulation, processing and
analysis of the numerical data. The numbers are converted into a processed or
unprocessed image for viewing. Digital cardiac and coronary angiographic systems
employ a video camera to acquire an electronic video image from the X-ray image
intensifier. This signal is converted into digital (numerical) form.

Types of cineangiograms:

Cineangiograms are usually performed after selective injection of contrast media in

the right ventricle (right ventriculogram), left ventricle (left ventriculogram), and/or
pulmonary artery (pulmonary aortogram). Selective injection into the right and left
coronary arteries constitutes a coronary cineangiogram (see coronary
arteriography). Injection of any of these sites may be necessary in congenital heart
disease in order to define the complete morphology of anomalies. In acquired heart
disease left ventriculography is performed most frequently for the evaluation of

valvular heart disease, ischemic heart disease and cardiomyopathies. Thoracic

aortography is performed for the evaluation of aortic valve disease, thoracic aortic
aneurysms and aortic dissection. Right ventriculography is performed to assess
right ventricular function and tricuspid valve function.

Ventriculograms are usually performed in the anteroposterior and lateral or 30 right

anterior oblique and 60 left anterior oblique projections. For the evaluation of
congenital heart disease and sometimes for acquired heart disease as well, a
compound angulated view is used with craniocaudal angulation combined with right
or left anterior oblique angulation of the image intensifier.

Analysis of cine ventriculograms

The left ventriculogram can be evaluated using subjective visualization or

quantitative analysis usually employing computer-based programs. Such computerbased quantitative analysis is facilitated by digital recording of image data. The left
ventriculogram is subjectively evaluated by visual assessment of ventricular size
and shape, wall thickness, wall motion during systole, motion of mitral and aortic
valves, and identification of intracavitary filling defects and valvular regurgitation.
While the volume of the ventricle can be subjectively estimated by experienced
examiners, measurement of the outline of left ventricle at end-diastole and endsystole is usually necessary to provide more precise estimation of left ventricular
volume at end-diastole and end-systole using various geometric models. The area
length method is the one usually applied for quantifying ventricular volumes.
Ventricular contraction can be readily evaluated by cineangiography. Abnormalities
of wall motion are generally global in nonischaemic cardiac diseases such as
valvular heart disease and cardiomyopathy. Wall motion abnormalities are usually
segmental in ischaemic heart disease and sometimes also in other diseases (Fig. 1).
The abnormalities in wall motion are termed: hypokinesis (decrease systolic inward
motion); akinesis (no systolic inward motion); dyskinesis (outward systolic motion)
(Fig. 2). These segmental wall motion abnormalities are displayed best on
cineangiograms acquired in the 30 right anterior oblique or caudal 30 right
anterior oblique projections (Fig. 1).

In congenital heart disease cineangiograms are analysed to assess dimension of the

two ventricles, arterioventricular connections, atrioventricular connections, valve
atresia, stenosis and regurgitation, shunts at atrial, ventricular and aortic levels, and

ventricular function. Cineangiograms are also employed before and after surgery to
assess the size of pulmonary arteries.