A COMPLICATION FOLLOWING CORONARY SINUS AND CARDIAC VEIN CATHETERIZATION IN MAN

Abstract

Right auricular catheterization in man is a safe and simple procedure, but the introduction of the catheter into the right ventricle and pulmonary artery is often technically more difficult and introduces new risks.Most of these can be avoided if their existence is recognized.The un- recognized entry of the catheter into a cardiac vein either via the coronary sinus or even directly from the right atrium constitutes one of these risks.In a total of approximately 300 right heart catheterizations at this hospital during the past two years, in which the prime object was to enter the right ventricle or pulmonary artery, there have been five such-complications.A preliminary report on three of these cases, tentatively labelled " coronary thrombosis " has al'ready been made by Zimdahl (1951).In all cases Cournand catheters were passed through the median basilic vein and directed under fluoroscopic control.A continuous slow infusion of heparanized 5 per cent glucose was maintained through the catheter.Over the next five da-ys she gradually improved, the blood pressure rising to 120/70 mm. after twenty-four hours.The pain persisted for five days, although gradually diminishing in intensity.Referred pain in the back was a predominant feature in this case.During the first three days a transient pyrexia up to 100°F.was seen.On the fifth day the patient was found to have auricular fibrillation and this rhythm change persisted for twenty-four hours, after which sinus rhythm returned.The erythrocyte sedimentation rate rose during the first week to 27 mm. in one hour (Westergren), returning to normal after a further week.There was no significant change in total white cell count.Serial electrocardiograms during the first five days (Fig. 1) showed progressive changes with S-T elevation and T wave inversion in V5, VF, and III without pathological Q waves.These were interpreted as indicating 397