Understanding the Musical Dance of the Engaged Coronary Catheter: Insights From Advanced Myocardial Mechanics

J INVASIVE CARDIOL 2018;30(9):E97-E98.

Key words: cardiac imaging, catheter, diagnostic angiography

Although coronary engagement is an hourly phenomenon in the cardiac catheterization laboratory, the characteristic rhythmic motion of the catheter tip, diagnostic of successful and stable engagement, has not been well described or correlated with advancements in echocardiographic myocardial mechanics. This case of a 56-year-old woman with normal coronaries displays the side-to-side motion of the unengaged JL4 catheter (Figure 1; Video 1) followed by the rhythmic up-and-down, piston-like movements of the catheter tip after engagement (Figure 2; Video 1) up in diastole and down in systole. The side-to-side motion is likely caused by the pulsatile systolic jet of blood from the ventricle across the aortic valve. As seen in standard echocardiography, the base of the ventricle contracts and moves downward during systole, whereas the apex stays stationary (Figure 3; Video 2). The velocity of this motion is further quantified via tissue Doppler imaging (Figure 4). The movement is primarily that of base moving to apex, as in a horizontal heart, the catheter tip will primarily move side to side, from base to apex (Figure 5; Video 3). A partial engagement of the ostium can be suggested without contrast injection, but not categorically separated from complete engagement, by the catheter tip motion alone (Figure 6, Video 4) because the sinus of Valsalva also moves vertically with the base of the ventricle, although the movement is slightly less marked. 

In 1640 AD, William Harvey wrote, “the motions of the heart are so complex, that I initially thought they are to be understood only by gods.”¹ This observation, as it defines and correlates the motion of the catheter tip with that of the heart, is not just intellectually satisfying, but potentially leads to less use of contrast and less catheter manipulation, resulting in reduced complications from either.

Figures 1-6

View Supplemental Videos here. 

Reference

1.    Harvey W. On the Motion of the Heart and Blood in Animals, 1628 Scientific Papers; Physiology, Medicine, Surgery, Geology, with Introductions, Notes and Illustrations. New York, NY: P. F. Collier & Son [c1910], The Harvard Classics v. 38.

From Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke’s Medical Centers, Milwaukee, Wisconsin.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

Manuscript accepted April 13, 2018. 

Address for correspondence: Khawaja Afzal Ammar, MBBS, Aurora Cardiovascular Services, Aurora St. Luke’s Medical Center, 2801 W. Kinnickinnic River Parkway, Ste. 840, Milwaukee, WI 53215. Email: publishing28@aurora.org