IMAGES IN INTERVENTION
Unintentional
“Ventriculo-Phlebo-Myo-Pericardiography
”
Olivier Gach, MD, PHD,*Mathieu Lempereur, MD,*Eric Eeckhout, MD, PHD,y
Victor Legrand, MD, PHD*
Liège, Belgium; and Lausanne, Switzerland
An 83-year-old woman with severe aortic steno-sis was referred for invasive evaluation. A left Amplatz II catheter was needed to cross the ste-notic aortic valve. Thereafter, an exchange wire
was used to insert a pigtail catheter in the left ventricular (LV) cavity. The operator did not realize that the Amplatz left catheter was inserted in the Thebesian venous system. Using the wire exchange, these veins were penetrated; once the pigtail was inserted, the distal holes were in
the venous system and the proximal holes in the LV. During ventriculography, opacification of the LV was obtained through the proximal holes
(Fig. 1A, Online Video 1), whereas injection in
the distal holes realized an unexpected opacifica-tion of the interstitial space, the myocardium, as well as the coronary vein system (Thebesian veins and the coronary sinus). Deep penetration and forced injection in these structures provoked a myocardial laceration, explaining opacification of the myocardium and pericardial effusion (Fig. 1B, Online Video 2).
Surgical aortic valve replacement was decided.
Perioperative findings consisted of marked
peri-cardial inflammation and periperi-cardial effusion. Myocardial hematoma and adhering thrombus were observed at the lesion site.
Figure 1.Opacification of the LV Cavity and Part of the Coronary Vein System, and Cineangiography Without Contrast Demonstrating Pericardial Opacification
(A) Left ventriculography showing opacification of the left ventricular (LV) cavity obtained through the proximal holes; injection in the distal holes realized an unexpected opacification of the interstitial space, the myocardium, and the coronary vein system. (B) Opacification of the myocardium and pericardial effusion.
From the *University of Liège, Centre Hospitalier Universitaire du Sart Tilman, Service de Cardiologie, Liège, Belgium; and theyService of Cardiology, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland. The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Manuscript received April 26, 2013; revised manuscript received July 12, 2013, accepted July 17, 2013.
J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L .-, N O .-, 2 0 1 4 ª 2 0 1 4 B Y T H E A M E R I C A N C O L L E G E O F C A R D I O L O G Y F O U N D A T I O N I S S N 1 9 3 6 - 8 7 9 8 / $ 3 6 . 0 0 P U B L I S H E D B Y E L S E V I E R I N C . h t t p : / / d x . d o i . o r g / 1 0 . 1 0 1 6 / j . j c i n . 2 0 1 3 . 0 7 . 0 2 4
Thebesian veins are small, valveless venous channels representing communication between the coronary artery and/or coronary venous system and a chamber of the heart. They are more common in the atria than in the ventricles, especially in the right chamber.
In the area of transcatheter aortic valve implantation, crossing the aortic valve is commonly realized. The present rare complication should be promptly recognized because of its potentially life-threatening implication.
Reprint requests and correspondence: Dr. Olivier Gach, University of Liège, Centre Hospitalier Universitaire du Sart Tilman, Service de Cardiologie, Domaine Universitaire du Sart Tilman (B 35), 4000 Liège 1, Belgium. E-mail:[email protected]
Key Words: cardiac catheterization-complications
-ventriculography.
Gachet al. J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S , V O L .-, N O . -, 2 0 1 4
“Ventriculo-Phlebo-Myo-Pericardiography” -2 0 1 4 :-–
