Experimental evidence of iatrogenic hydrodynamic injury of arterioles following invasive coronary angiography

Objective. To study the influence of technical aspects of coronary angiography, such as depth, coaxiality of catheter placement, intensity and duration of contrast agent administration, on development of intramural (subepicardial) hematomas in atrial myocardium following hydrodynamic injury as one of the rarest consequences of cardiac catheterization. Material and methods. An experimental protocol was developed using a pig heart specimen harvested from the animal no later than 2 hours before the experiment. Coronary arteries were catheterized using standard cardiac surgical cannulas for antegrade selective cardioplegia with 4-mm inflatable balloon (polyvinyl chloride+silicone). Filling of coronary arteries with excess volume of contrast agent was performed using angiographic 10.0-ml syringe and Omnipaque (350 mg iodine/ml) under fluoroscopy and radiography (frame rate 30 frames per second). Results. After tight filling of catheterized arteries under fluoroscopic control, we obtained lacunar extravasations in terminal segments of atrial branches of the right coronary artery. These extravasates did not have visible external ruptures of surface and were visually located in subendocardial layer. Conclusion. Experimental data once again emphasize the need for test delicate contrast enhancement of arteries during selective catheterization to select the optimal position of catheter tip and subsequent mode of contrast agent injection.