Complete heart block complicating retrograde left heart catheterization

Three cases of complete heart block complicating retrograde left heart catheterization are presented. In two of the three cases, electrophysiologic study documented block below the AV (atrial ventricular) node. In the third recurrent complete heart block was fatal. It appears that complete heart block complicating retrograde left sided cardiac catheterization is not simply a pericatheterization event; rather, it appears that there is high risk of recurrent complete heart block and that electrophysiologic study is mandatory.     

Complete heart block complicating retrograde left ventricular catheterization: Case report and review

Complete heart block (CHB) following retrograde left ventricular catheterization is uncommon. We report a case of transient CHB in a patient with severe aortic stenosis and bifascicular block on the baseline surface electrocardiogram during retrograde left ventricular catheterization. The block resolved spontaneously without sequelae. A review of the literature using MedLine was performed and recommendations for temporary and permanent pacing are outlined.     

Complete heart block complicating retrograde left-heart catheterization of patients with cardiac allografts

The development of complete heart block during left-sided cardiac catheterization is an uncommon event. We describe three cases of complete heart block complicating leftsided cardiac catheterization of patients with cardiac allografts. Review of the cases performed at our institution suggests that complete heart block during left-sided cathe-terization may be more common in patients with cardiac allografts. © 1992 Wiley-Liss, Inc.     

Complete heart block complicating retrograde left-heart catheterization of patients with cardiac allografts.

The development of complete heart block during left-sided cardiac catheterization is an uncommon event. We describe three cases of complete heart block complicating left-sided cardiac catheterization of patients with cardiac allografts. Review of the cases performed at our institution suggests that complete heart block during left-sided catheterization may be more common in patients with cardiac allografts.     

Complete atrioventricular block induced during left heart catheterization

Complete atrioventricular block (CAVB) during cardiac catheterization is a rare complication. We describe a patient with preexisting complete right bundle branch block who developed CAVB during left-sided cardiac catheterization. CAVB was induced when a left-sided catheter was passed through the aortic valve. We speculate that the patient's His bundle was injured by mechanical compression. Physicians should always pay attention to the possibility of the development of CAVB during cardiac catheterization, particularly in patients with preexisting heart block.     

Complete heart block complicating pregnancy

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1. The case history of a pregnant woman with complete A-V heart block has been presented.     

Ventricular standstill complicating left heart catheterization in the presence of uncomplicated right bundle branch block.

We report the unusual occurrence of complete heart block during attempted right coronary artery cannulation in a patient with pre-existing uncomplicated right bundle branch block (RBBB). This complication occurred due to accidental impingement of the Judkin's right coronary catheter on the left bundle when it transiently slipped across the aortic valve. The block resolved without any complication.     

New technique for retrograde left heart catheterization in aortic stenosis

Retrograde catheterization of the left ventricle in patients with aortic stenosis is frequently difficult and occasionally impossible. We have developed a new technique to facilitate this problem. A standard #8 “pigtail” catheter is preformed with a 145° angle 7 cm from the catheter tip. With this catheter in the ascending aorta, the preformed angle lifts the catheter tip leftward and superiorly, allowing a straight guidewire a direct approach to the orifice of the stenotic aortic valve. Utilizing this technique, we were able to cross the stenotic aortic valve in 26-29 consecutive patients with isolated aortic stenosis (mean gradient ± 0.22 cm₂, mean fluoroscopy time for crossing: 32 ± 40 seconds). The 145° angle also lifts the catheter off the posterior wall of the left ventricle and allows a more parallel alignment of the catheter with the long axis of the left ventricle, leading to a more stable position with less ventricular dysrhythmias during angiography. Thus a preformed angle in the “pigtail” catheter facilitates crossing of the stenotic aortic valve and produces a more stable position in the left ventricle.     

Complete heart block during cardiac catheterization in a normal individual

A 44-year-old white male who developed third-degree heart block during cardiac catheterization is presented. Right heart catheterization precipitated bifascicular block, right bundle branch block with left posterior hemiblock, and resulted in third-degree heart block during the left heart procedure. It is recommended that multiple electrocardiographic lead monitoring be considered during cardiac catheterization in order to recognize more easily high-risk conduction disturbances, ie a bifascicular block pattern with frontal plane axis shifts.     

Eversion endarterectomy complicating radial artery access for left heart catheterization.

The use of the radial artery for arterial access for left heart catheterization is gaining popularity. We report the first case of traumatic eversion endarterectomy following the removal of the arterial sheath after the cannulation of the radial artery. The patient has no long-term vascular compromise of the limb and did not require surgical intervention.     

New preformed catheter and method for retrograde left atrial or complete left heart catheterization

Employing a new catheter and technique complete retrograde left heart catheterization was accomplished in 96 of 100 consecutive patients. These 96 patients included 37 with ischemic heart disease, 13 of 17 with isolated aortic valve deformities, 11 with isolated rheumatic mitral valve deformities, 10 with combined rheumatic aortic and mitral valve deformities, and 25 with other problems. The only failures were in 4 (of 27) patients with aortic valve deformities. No untoward complications occurred. The retrograde catheterization fluoroscopy time was usually less than 2 minutes. The shortest time was 44 seconds, the longest, 6 minutes and 2 seconds. These data indicate that this new catheterization method achieves safe, reliable (when the aortic valve is not deformed), simple, and rapid complete left heart catheterization. They further indicate it may be useful in assessing patients with mitral stenosis, pulmonary hypertension, hypertrophic obstructive cardiomyopathy, and left-to-right shunt problems.