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DOI: 10.1055/s-0031-1297884
A hidden guide wire after coronary angiography- four years lost in the body
Introduction: Complications after coronary angiography (CA) may have serious implications. While the majority of acute complications is easily controllable, in rare occasions major adverse cardiac and cerebrovascular complications have to be considered.
We present a 70-year-old male, suffering from a rare complication that occurred with a delay of five years after coronary angiography.
Aims: Three years after CA the patient observed recurrent cerebral ischemias. During the prior diagnostics an interatrial septum aneurysm with an accompanied patent foramen ovale (PFO) was observed. In addition a foreign body became evident in ultrasound examination. In the subsequent chest-x-ray this radio-opaque foreign body could be identified as a guide wire.
The preoperative diagnostics was completed by performing an ECG-gated aortic MD-CT. With this the dimensions of the guide wire became obvious. It reached from the aortic root to the iliac artery bifurcation. As it remained unclear, whether the septum aneurysm or the guide wire were responsible for the clinical pathology, the indication for surgery was accepted.
Intraoperatively the aorta ascendens was cross-clamped followed by the transversal incision of the aorta ascendens two centimeters distal the sinutubular junction. Herewith it became obvious, that the guidewire-catheter was located in communication with the ostium of the right coronary artery. Therefore the cross-clamp was partially opened and the catheter was extracted through the aortic inscision. Thereafter the Atrial-Septum-aneurysm was closed with an autologous pericardial patch via a right atrial inscision.
The postoperative course was prolonged by seizure and a transitory psychotic syndrome, finally the patient could be transferred to post-hospital curative treatment on postoperative day 15.
Discussion: Intraaortic/Intracoronary foreign bodies represent a very rare entity of complications after coronary angiography. Most frequently, it is caused by detachment of the distal catheter tip caused by a trapped guide wire. If untreated, und maybe unknown as presented above, they may contribute serious cardiovascular complications. Although an aneurysm of the intraatrial septum per se may cause severe cebrebral damge due to emboli, it can't be excluded, that the guide wire may have contributed to the pathology of this patient.