How is LV pullback performed?

• A. Pigtail starts in the LV and then pulled into the Aorta
• B. Pigtail starts in the LA and then pulled into the LV
• C. Pigtail starts in the RV and into the PA
• D. Pigtail starts in the PA and into the LA

Answer: (A)

The main idea is to measure the pressure gradient between the left ventricle and the aorta by withdrawing the catheter from LV into the aorta. A pigtail catheter is placed with its tip in the left ventricle and then slowly pulled back across the aortic valve into the ascending aorta. By recording pressures at multiple points as the catheter moves, you can identify where the pressure drops and localize the site of obstruction (subvalvular LVOT or valvular aortic stenosis) and quantify the gradient.

This approach directly compares LV systolic pressure to aortic pressure and shows how the gradient changes as you cross the LVOT and the aortic valve. Other routes, like starting in the left atrium, right heart chambers, or pulmonary artery, would not provide the LV-to-aorta gradient needed for assessing LV outflow tract or aortic valve obstruction.