NIH catheter induced RV perforation in a patient of tetralogy of fallot
Journal Title: Journal of the Indian Medical Association - Year 2018, Vol 116, Issue 9
Abstract
Using a side-hole catheter for RV angiogram is a standard protocol. Perforation of RV during this procedure caused by the power of injection is a very rare complication and not well reported in literature. Here we are reporting a case of free wall perforation during RV angiogram induced by a NIH catheter. A 5 year girl (10 kg) with a diagnosis of tetralogy of fallot was planned for preoperative cath study. RV was catheterized with a 5F NIH catheter (Cordis, Cashel, Ireland) with 4 side-holes. Angiogram was obtained with Iohexol contrast (15 ml, at 10 ml / second, 700 psi pressure limit). Immediately after the injection there was a perforation of RV free wall with resultant spillage of blood and contrast into pericardial cavity. The baby became hemodynamically unstable and ultimately developed cardiac arrest. Probably one of the side holes lied firmly against the endocardium. We started cardiopulmonary resuscitation, withdrawn the catheter, reversed the heparin with protamine sulfate introduced a 5 F sheath into pericardial cavity and 90 ml of blood was evacuated. After the pericardiocentesis the baby’s hemodynamic parameters started improving gradually. We kept the pericardial sheath overnight and there were no further complications. In tetralogy of fallot, generally the RV is very much hypertrophied. Encountering a perforation of RV free wall by a side-hole angiography catheter is an extremely unusual circumstance.
Authors and Affiliations
Arindam Pande, Soumya Patra, Achyut Sarkar, RABINDRA NATH CHAKRABORTY
Keywords
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