Complications of Left Heart Angiography

A study of 1,000 consecutive left heart cineangiocardiograms was made to determine the frequency of various complications. Ten per cent of angiographic procedures caused minor complications such as nausea, vomiting, transient arrhythmias, loss of pulse, or hives. Most of these complications were gone before the patient left the cardiac catheterization laboratory. Major problems were associated with 3.1% of the angiograms performed. The majority involved either vessel thrombosis (1.2%) or cardiac complications such as arrhythmias, intramyocardial dye injection, or myocardial infarcts (1.4%). Femoral arterial thrombosis was especially frequent in patients with mitral valve disease and low cardiac index. The use of lidocaine-lubricated catheters, tape traction hemostasis, and Fogerty catheter clot removal virtually eliminated brachial arterial thromboses. This route is now used almost exclusively for left heart angiography at our institution. Most cardiac complications resulted from open-end catheter angiography, especially through transseptal catheters. The frequency of major cardiac complications has decreased markedly since the regular use of closed-tip catheters via the brachial artery route was begun for left heart angiography.