Persistent primary coronary dilation induced by transatrial delivery of nitroglycerin into the pericardial space: a novel approach for local cardiac drug delivery
Sergio Waxman, MD*  ,
Ricardo Moreno, BA,
Katharine A. Rowe, AB* and
Richard L. Verrier, PhD, FACC*
* Cardiology Division and Institute for Prevention of Cardiovascular Disease, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA
Harvard Medical School, Boston, Massachusetts, USA
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Figure 1 Fluoroscopic images demonstrating the method for transatrial pericardial access. (A) The 8-F guide catheter (arrows) rests against the wall of the right atrial appendage. (B) The needle catheter (arrow) is protruding through the wall of the right atrial appendage into the pericardial space. (C) The guide wire (arrows) has been advanced through the needle catheter into the pericardial space. (D) The 4-F delivery catheter (arrows) has been advanced over the wire through the appendage wall and positioned in the pericardial space.
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Figure 2 Bar graph comparing the effects of intrapericardial (diamonds) and intracoronary (squares) nitroglycerin on left anterior descending coronary artery luminal area as assessed by intravascular ultrasound. The asterisks indicate significance with respect to baseline value (***p < 0.001, **p < 0.01, *p < 0.05). The curves were statistically different using two-way analysis of variance (p = 0.03). Values are presented as means ± standard errors.
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