Complications of coronary arteriography and left heart catheterization

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The first selective coronary arteriograms were performed in the Cardiac Laboratory of The Cleveland Clinic Foundation in 1959. Since that time, through the calendar year 1976, 52,953 angiographic studies which included selective coronary arteriography and left ventriculography have been performed. The complications encountered in this group of patients are summarized in the Table.

Thirty-nine patients (0.07%) died during or subsequent to the procedure. The majority of these died within 24 hours. A few died as long as a week after catheterization as a result of a chain of events which began at the time of catheterization.

Myocardial infarction was encountered in 16 instances (0.03%). These accounted for 12 of the deaths previously noted.

Documented dissection of a coronary artery was seen seven times (0.013%); four patients died; three recovered after prompt surgical intervention with appropriate placement of bypass vein grafts.

There were two instances of coronary embolization. One of these occurred following left ventriculography in a patient with a prosthetic aortic valve. The other occurred immediately after selective left atrial opacification in a patient with severe mitral stenosis.

Cerebral vascular accidents which resulted in long-term neurologic deficits have been encountered on four occasions (0.008%). These occurred as complications of difficult catheter manipulation in patients with elongated aortas and tortuous innominate-subclavian systems or incidental to left ventriculography. Catheter perforation of the subclavian or innominate artery has occurred in four patients (0.008%) with similar anatomic problems.

Perforation of the left ventricle occurred in four patients as a complication of intramyocardial injection of . . .



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