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Cardiac catheterization is an invasive diagnostic technique used to identify and evaluate structural and functional diseases of the heart and major blood vessels. This technique diagnoses congenital heart disease, coronary artery disease, valvular heart disease, and coronary spasms and assesses ventricular function. It helps guide treatment decisions, including the need for revascularization procedures like percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) and...
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Inadvertent cardiac phlebography.

Konstantinos Aznaouridis1, Constantina Masoura1, Stylianos Kastellanos1

  • 1Konstantinos Aznaouridis, Constantina Masoura, Stylianos Kastellanos, Albert Alahmar, Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom.

World Journal of Cardiology
|July 15, 2017
PubMed
Summary

A case report highlights a potential risk during left ventriculograms using radial catheters. A normal pressure waveform does not guarantee correct catheter placement, as seen in this effort angina patient.

Keywords:
Cardiac phlebographyRadial accessThebesian veinTransradial

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Area of Science:

  • Cardiology
  • Interventional Cardiology
  • Diagnostic Imaging

Background:

  • Coronary angiography is a key diagnostic tool for patients with suspected or known coronary artery disease.
  • Left ventriculography is performed to assess left ventricular function and morphology during coronary angiography.
  • Radial artery access is increasingly preferred for its safety and patient comfort.

Observation:

  • A dedicated radial multipurpose 5 French Optitorque Tiger catheter was used for coronary angiography and left ventriculography in an 80-year-old female with effort angina.
  • The catheter was advanced into the left ventricle, and a left ventriculogram was obtained.
  • Despite an apparently optimal catheter position and normal pressure waveform, the catheter's end hole inadvertently cannulated an endocardial opening of a thebesian vein.

Findings:

  • Opacification of a large posterior interventricular vein draining into the right atrium occurred.
  • This opacification was attributed to retrograde filling of the epicardial vein via the thebesian vein.
  • The findings suggest potential catheter malposition despite a normal left ventricular pressure waveform.

Implications:

  • Caution is advised when using radial catheters with both end-holes and side holes for ventriculography.
  • A normal left ventricular pressure waveform may not reliably exclude inadvertent catheter engagement with endocardial structures.
  • This case underscores the importance of meticulous technique and awareness of potential complications during interventional cardiology procedures.