Case Report
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Jun 26, 2017; 9(6): 558-561
Published online Jun 26, 2017. doi: 10.4330/wjc.v9.i6.558
Inadvertent cardiac phlebography
Konstantinos Aznaouridis, Constantina Masoura, Stylianos Kastellanos, Albert Alahmar
Konstantinos Aznaouridis, Constantina Masoura, Stylianos Kastellanos, Albert Alahmar, Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Cottingham HU16 5JQ, United Kingdom
Author contributions: Aznaouridis K and Alahmar A designed the report and revised the drafted manuscript; Masoura C collected the clinical data and drafted the manuscript; Kastellanos S collected the clinical data and drafted the manuscript.
Institutional review board statement: This case report was exempt from the Institutional Review Board standards at Hull and East Yorkshire NHS Trust, Hull, United Kingdom.
Informed consent statement: The involved patient gave her informed consent prior to study inclusion.
Conflict-of-interest statement: None.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Konstantinos Aznaouridis, PhD, Cardiology Department, Castle Hill Hospital, Hull and East Yorkshire NHS Trust, Castle Rd, Cottingham HU16 5JQ, United Kingdom. konstantinos.aznaouridis@hey.nhs.uk
Telephone: +44-1482-622294
Received: October 28, 2016
Peer-review started: October 29, 2016
First decision: January 14, 2017
Revised: February 10, 2017
Accepted: April 6, 2017
Article in press: April 10, 2017
Published online: June 26, 2017
Processing time: 240 Days and 20.1 Hours
Abstract

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.

Keywords: Thebesian vein; Radial access; Transradial; Cardiac phlebography

Core tip: Use of a dedicated radial catheter with both an end-hole and a side hole to perform a left ventriculogram, can result in inadvertent cannulation of a small Thebesian vein and subsequent opacification of a large epicardial vein. When such catheters are used for ventriculogram, a normal ventricular pressure waveform does not exclude malposition of the end-hole against the ventricular wall and extra caution is needed in order to prevent iatrogenic myocardial injury. We review current literature on myocardial injury induced by end-hole catheters used for left ventriculograms.