Video Supplement to “Accidental Cannulation of the Cardiac Venous System During Pericardiocentesis,” by Gupta, et al. (March Clinical Images).
A 52-year-old woman was diagnosed with a massive pericardial effusion and underwent pericardiocentesis. However, the patient’s symptoms did not improve. On evaluation, the patient had a large pericardial effusion and evidence of cardiac tamponade, but no fluid could be aspirated from the sheath. We attempted intrapericardial placement of a guidewire through the sheath to allow the insertion of a pigtail catheter. A 0.035˝ J-tipped Terumo wire was inserted, and it coursed through the right ventricle into the right atrium and inferior vena cava. The following angiogram shows the sheath to be communicating with a tributary of the middle cardiac vein with contrast opacification of the coronary sinus and right atrium, and spillage of dye into the pericardium.