PP-458 - Coronary Arterio-Venous Angiogram With Massive Myocardial Staining

Abstract

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 may results in dye extravasating into peri-coronary space. Indeed, the half of circumference of the coronary artery is represented by the myocardium and the remaining is related directly to the pericardial aspect. A 37-year-old female undergone angiography for investigation of chest pain via the right femoral approach. The left coronary angiogram revealed normal coronary arteries. However, repeated attempts at cannulating the selective right coronary artery were unsuccessful and failed to visualize the ostium due to preferentially cannulation of separate origin of a conus branch. We considered to perform a “hit and run” technique; but unfortunately, massive myocardial staining of interventricular septum (white arrow in Figure 1) developed with visualization of the thebesian vein (black arrow in Figure 1) and coronary venous sinus (gray arrow in Figure 1). Fortunately, no arrhythmia developed. The thebesian veins are valveless conduits arising from all four cardiac chambers and communicating with the coronary sinus. Various forms and courses of the intramural venous tunnel, sinus or channel of the right atrium have been also found. This images illustrates the value of careful manipulation and positioning of the coronary catheter during coronary angiogram. It is imperative to check the position of the catheter tip with a small amount of contrast injection prior to coronary angiography to avoid these types of complication.