Myocardial and Pericardial Staining by Transradial Optitorque Jacky Shape Catheter During Left Ventriculogram

Abstract: A 69-year-old male presented with inferior wall ischemia. Transradial coronary angiogram with an Optitorque Jacky shape catheter showed unobstructed coronary arteries (Terumo Medical Corporation). Left ventriculography was complicated with myocardial and pericardial contrast staining. The catheter was pulled back. The patient experienced sharp chest pain that resolved in 20 minutes. Stat transthoracic echocardiogram was unremarkable. The patient remained hemodynamically stable. Transthoracic echocardiogram the next morning revealed trivial pericardial effusion. Patient was asymptomatic on outpatient follow-up. The Optitorque transradial catheter, with Jacky and Tiger tip shapes, is the preferred multipurpose catheter for transradial coronary angiogram. Potential complications of ventriculogram catheters are myocardial staining, myocardial rupture, cardiac tamponade, and arrhythmias caused by improper position of the catheter tip. It is imperative to check the position of the catheter tip with a small amount of contrast injection prior to left ventriculography (even though we checked our position with a small test injection) to avoid these types of complication. This case illustrates the value of careful manipulation and placement of transradial catheter during left ventriculography.

J INVASIVE CARDIOL 2012;24:128

Key words: Optitorque catheter, transradial complications

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Case Description

A 69-year-old male presented with inferior wall ischemia. Transradial coronary angiogram with an Optitorque catheter with Jacky shape tip (Terumo Medical Corporation) showed unobstructed coronary arteries. Left ventriculography was complicated with myocardial and pericardial contrast staining (Figures 1A, 1B, and 1C; video available at www.invasivecardiology.com). The catheter was pulled back. The patient experienced sharp chest pain that resolved in 20 minutes. Stat transthoracic echocardiogram was unremarkable. The patient remained hemodynamically stable. Transthoracic echocardiogram the next morning revealed trivial pericardial effusion (Figure 1D). The patient was asymptomatic on outpatient follow-up. The Optitorque transradial catheter with Jacky and Tiger shape tips is the preferred multipurpose catheter for transradial coronary angiogram. Potential complications of ventriculogram catheters are myocardial staining, myocardial rupture, cardiac tamponade, and arrhythmias caused by improper catheter tip position. It is imperative to check the proper position of the catheter tip prior to left ventriculography (even though we checked our position with a small test injection) to avoid these types of complication. The operator should carefully look at the waveform from the transducer to ensure that catheter tip is in the mid left ventricle rather than base and also confirm with hand-held test injection in right and left anterior oblique views that the catheter tip is not against the wall. This case illustrates the value of careful manipulation and placement of transradial catheter during left ventriculography. 

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From the ¹Kettering Medical Center, Kettering, Ohio, ²Wright State University/Boonshoft School of Medicine, Dayton, Ohio, Loma Linda University, Loma Linda, California, and the University of Cincinnati, Cincinnati, Ohio.
Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.
Manuscript submitted September 12, 2011, provisional acceptance given October 11, 2011, final version accepted October 24, 2011.
Address for correspondence: Abdul Basit, MD, 3535 Southern Blvd. Kettering Medical Center, Kettering, OH 45429. Email: basetmd@yahoo.com