Left ventricular angiography with a Jacky Radial catheter at high pressure leading to myocardial staining and opacification of the great cardiac vein and coronary sinus

Kang, Gurjaipal; Kang, Kevin H.; Jurado, Javier A.; Byrnes, Luke

doi:10.4244/eijv8i3a62

Cited by 3 publications

(6 citation statements)

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“…The characteristics of the patients and procedures and the type of myocardial injury and outcome are shown in Table 1. In 5 of those cases, a dedicated transradial end-hole catheter with one side hole near the tip (radial Tiger catheter) or two side holes (radial Jacky catheter) was used[4,6,7,9,10]. Traditional multipurpose (MPA) catheters with an end-hole and 2 side holes near the tip were used in 2 cases[4,5], whereas a catheter with a single end-hole (Judkins right 4) was used from femoral access in 1 case[8].…”

Section: Discussionmentioning

confidence: 99%

“…Traditional multipurpose (MPA) catheters with an end-hole and 2 side holes near the tip were used in 2 cases[4,5], whereas a catheter with a single end-hole (Judkins right 4) was used from femoral access in 1 case[8]. The Thebesian venous network and/or cardiac veins were visualized in 4 cases[4,5,8,9]. A high-pressure power injection had been performed in most cases describing myocardial laceration/dissection and persistent myocardial staining[6,7,9,10].…”

Section: Discussionmentioning

confidence: 99%

“…The Thebesian venous network and/or cardiac veins were visualized in 4 cases[4,5,8,9]. A high-pressure power injection had been performed in most cases describing myocardial laceration/dissection and persistent myocardial staining[6,7,9,10]. Complete myocardial “perforation” with presence of contrast in the pericardial space was confirmed in 2 of those cases[6,10], and emergency pericardiocentesis due to tamponade was performed in one patient[6].…”

Section: Discussionmentioning

confidence: 99%

“…In this scenario, it seems that the injected contrast drains through the Thebesian network into the cardiac veins and therefore no significant intramyocardial shearing forces are generated. However, serious complications such as laceration/dissection of the myocardium or even catastrophic “perforation” of the ventricular wall[6,7,9,10] may occur when the contrast is injected against the endocardium, or when of a large contrast volume is injected in a Thebesian vein with high-pressure (with an automated power injector), as in this case the small Thebesian network would likely be unable to accommodate the forcefully injected large volume of contrast. Hence, we believe that our case indirectly supports the common practice of avoiding the use of radial multipurpose catheters with automated high-pressure power injectors and large volume of contrast for ventriculograms.…”

Section: Discussionmentioning

confidence: 99%

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Inadvertent cardiac phlebography

Aznaouridis

Masoura

Kastellanos

et al. 2017

WJC

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We are reporting a case of a 80-year-old lady with effort angina who underwent coronary angiography through the right radial artery, using a dedicated radial multipurpose 5 French Optitorque Tiger catheter. The catheter was advanced into the left ventricle and a left ventriculogram was obtained, while the catheter appeared optimally placed at the centre of the ventricle and the pressure waveform was normal. A large posterior interventricular vein draining into the right atrium was opacified, presumably because the catheter’s end hole inadvertently cannulated an endocardial opening of a small thebesian vein, with subsequent retrograde filling of the epicardial vein. Our case suggests that caution is needed when a dedicated radial catheter with both an end-hole and a side hole is used for a ventriculogram, as a normal left ventricular pressure waveform does not exclude malposition of the end-hole against the ventricular wall.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Inadvertent cardiac phlebography

Aznaouridis

Masoura

Kastellanos

et al. 2017

WJC

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“…Our case demonstrates a recently described complication with potentially catastrophic consequences [1][2][3]. It shows that a normal LV pressure waveform(likely from the side hole) does not exclude unsafe positioning of the end-hole against the ventricular myocardium.…”

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confidence: 82%

A Tear in the Heart: Myocardial Laceration Following Left Ventriculogram With a Dedicated Radial Catheter

Rossington

Aznaouridis

Davison

et al. 2016

The American Journal of the Medical Sciences

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Massive Myocardial Staining and Thebesian Venous Opacification during Complicated Coronary Angiography

et al. 2015

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Myocardial staining is a complication of coronary angiography or intervention procedures and consists of extravasations of contrast material into the myocardium. The powerful injection of contrast (myocardial staining) is caused by the improper positioning of the angiography or guiding catheter and can lead to refractory ventricular tachyarrhythmias and occasionally cardiac death. It results in small puffs of dye extravasating into pericoronary space. Indeed, the coronary arteries have two distinct anatomical relationships with reference to epicardium and pericardial space. Half of the circumference of the coronary artery is represented by the myocardium and the remaining is related directly to the pericardial aspect. Case ReportA 69-year-old male patient underwent angiography for investigation of chest pain via the left radial approach.The left coronary angiogram revealed normal coronary arteries. However, repeated attempts at cannulating the right coronary artery were unsuccessful and failed to visualize the ostium because of preferential cannulation of separate origin of a conus branch. Moreover, there was also pressure dampening before the right coronary artery injection. Then, we considered to perform a "hit and run" technique; but unfortunately, massive myocardial staining of right ventricular outflow tract (RVOT) developed (►Fig. 1 and ►Video 1) and then immediately the catheter was pulled back. Visualization of the thebesian vein (black arrows), coronary vein, and sinus was also seen (Video 1). Emergency bedside hand-carried echocardiography showed no pericardial effusion. The patient remained asymptomatic without hemodynamic or arrhythmic compromise, though the myocardial staining appearance persisted on fluoroscopy. Then, we performed an aortic root angiogram after about 10 minutes of coronary angiogram to exclude possible iatrogenic aortic dissection, which showed no dissection flap but persistent RVOT myocardial staining (►Video 2). The course of our patient was uneventful, then he underwent a follow-up at coronary care unit approximately for 12 hours withelectrocardiography (ECG).The continued ECG monitoring showed no changes. The next day, control fluoroscopy revealed the complete resolution of myocardial staining. He was discharged from hospital 2 days after the procedure. At present, this patient is being followed at the outpatient clinic. Keywords► myocardial staining ► coronary angiography ► complication AbstractMyocardial staining is a complication of coronary angiography or intervention procedures and consists of extravasations of contrast material into the myocardium. The powerful injection of contrast (myocardial staining) is caused by the improper positioning of the angiography or guiding catheter and can lead to refractory ventricular tachyarrhythmias and occasionally cardiac death. It results in small puffs of dye extravasating into pericoronary space (epicardial or myocardial).We presented an interesting image of a massive myocardial staining and dense coronary and thebesian venous opac...

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Left ventricular angiography with a Jacky Radial catheter at high pressure leading to myocardial staining and opacification of the great cardiac vein and coronary sinus

Cited by 3 publications

References 0 publications

Inadvertent cardiac phlebography

Inadvertent cardiac phlebography

A Tear in the Heart: Myocardial Laceration Following Left Ventriculogram With a Dedicated Radial Catheter

Massive Myocardial Staining and Thebesian Venous Opacification during Complicated Coronary Angiography

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