Contrast pericardiography facilitates intrapericardial navigation under fluoroscopy

Background: We used contrast pericardiography during fluoroscopy to facilitate intrapericardial navigation in pigs.

Methods: In 8 juvenile pigs, we performed standard, noncontrast-enhanced fluoroscopy of the heart in an attempt to identify the location of the left and right atrial appendages, the atrioventricular (AV) groove, the coronary sinus, the superior and inferior vena cavae, and the right ventricular outflow tract. Then we injected ionic contrast into the pericardial space and repeated fluoroscopy. A subjective scoring sheet was used to grade the fluoroscopic image. Guided by the enhanced image, we placed a cardiac restraint device (CRD) around both ventricles. After 4 weeks, the pigs were humanely euthanized, and we examined the position of the CRD to verify that we had correctly identified the AV groove as well as the gross and histologic effects of intrapericardial contrast on the heart.

Results: Cardiac structures that were not visible on standard fluoroscopy could be delineated with substantially better clarity after intrapericardial injection of contrast. Postmortem examination showed that the CRD was positioned correctly at the AV groove and that contrast pericardiography was not associated with adverse topical effects.

Conclusions: Contrast pericardiography is a technique that greatly enhances one's ability to visualize the location and configuration of cardiac structures. We used this technique to accurately locate the AV groove and to aid us in the successful placement of a CRD. Improved fluoroscopic visualization of intrapericardial structures may facilitate the development of limited access and percutaneous intrapericardial interventions.