Inadvertent cardiac phlebography

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.