Diagram of the left heart RAO view

To help understand the following left ventriculogram from our patient, a diagram of the left heart is shown in the right anterior oblique view. The left atrium, left ventricle, and aorta are labeled. The tip of the pigtail catheter is positioned in the left ventricle. The motion of the left ventricle from diastole to systole is also indicated by the arrows.

Diastolic still-frame of left ventriculogram

This is a diastolic still frame of a left ventriculogram in the right anterior oblique view from our patient. The tip of the pigtail catheter is in the left ventricle. The left ventricle, ascending aorta, and descending aorta are opacified, and the aortic valve leaflets are closed. there is no contrast material in the left atrium.
An egg-shaped, unopacified area is identified by the arrows and represents the bulging of the stenotic mitral valve into the left ventricle, a characteristic finding in this disease.
In the real-time study that follows, note that the walls of the left ventricle move well and that no mitral regurgitation is present.

Pressure tracings

These are the left ventricular and left atrial pressure tracings of our patient.
They clearly show an elevated left atrial pressure and a significant mean diastolic gradient across the mitral valve of 25 mmHg. the calculated valve orifice size is .8 cm2, reflecting severe mitral stenosis.
Note also the high mean pulmonary artery pressure, reflecting severe pulmonary hypertension, the elevated right atrial “v” wave, reflecting tricuspid regurgitation, and the low cardiac index, reflecting low output.
In addition, the patient’s coronary arteries were angiographically normal.