A specific notation for contrast medium and dehydrated ethanol injection
into the vein of Marshall during mitral isthmus ablation----A Case
report
Abstract
Ablation of the vein of Marshall (VOM) by dehydrated ethanol (DE) is an
important method for completely blocking the mitral isthmus (MI). Before
DE ablation of the VOM, Marshall angiography should be performed so that
the contrast medium is inevitably exposed to DE. Here, we present a case
of DE ablation of the VOM. When iodixanol was exposed to DE, some
[floccule](javascript:;) embolized the lumen of the over-the-wire
(OTW) balloon dilatation catheter and led to the impossibility of DE
ablation. Then, we performed in vitro experiments: iodixanol, not
iomeprol, produced many stable white floccules when it encountered DE.
Our report showed that iodixanol is not an
[appropriate](javascript:;) contrast for DE ablation of the VOM.
However, if there is no other alternative contrast, the following
methods might be used to address the problem: ⑴ diluted iodixanol
(iodixanol: normal saline 1:1) could be used for VOM ablation; or ⑵ the
lumen of the OTW could be flushed by NS after VOM angiography, and then
DE injection could be performed.