Angled angiographic views demonstrated two areas of significant systolic narrowing in an anomalous right coronary artery arising in common with a left coronary artery from above the left sinus of Valsalva: 1) an ostial stenosis due to kinking as the anomalous artery turned sharply to the right after its origin from the aorta; 2) compression of the proximal segment as it coursed between the aorta and pulmonary artery. Appropriate angiographic studies to evaluate the presence of these changes may help to elucidate their significance.
Thromboembolic complications occurred during diagnostic coronary arteriography in three patients in spite of systemic heparinization. These mishaps were associated with the use of a nonionic contrast medium, which is known not to have a significant protective effect on coagulation pathways. If nonionic contrast media are to be used in angiographic studies of critical organs, meticulous technique is imperative, and adequate systemic heparinization is recommended.
A study of 72 patients angiographically examined by the percutaneous transbrachial technique with 4-5F catheters is reported. Even though the patients were preselected to reduce the risk of the technique, an unacceptably high incidence (7%) of major complications, including 3 patients requiring surgery for brachial thrombosis, was encountered. Although transbrachial catheterization with single 4F catheter midstream injections as reported in the literature may be safe, this technique is unwarranted when selective studies are planned and the alternative transfemoral approach is available.
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