Bujan Kovač, Andreja

Lovrić, Daniel

Lučev, Lucija

Pašara, Vedran

Perković, Romana

Šulentić, Vlatko

English

Hrčak - Portal of scientific journals of Croatia

2022;17(9-10):287.14. kongres Hrvatskoga kardiološkog društva s međunarodnim sudjelovanjem14th Congress of the Croatian Cardiac Society with International ParticipationZagreb, November 24-27, 2022Acute and intensive cardiology   Extended AbstractContrast-induced encephalopathy after coronary angiography in a heart transplant recipient: a case reportVedran Pašara1*,Lucija Lučev2,Vlatko Šulentić1,Andreja Bujan Kovač1,Romana Perković1,Daniel Lovrić11University Hospital Centre Zagreb, Zagreb, Croatia2University of Zagreb, School of Medicine, Zagreb, Croatia KEYWORDS: contrast-induced encephalopathy, heart transplant, cardiac allograft vasculopathy, coro-nary angiography.CITATION: Cardiol Croat. 2022;17(9-10):287. | https://doi.org/10.15836/ccar2022.287*ADDRESS fOR CORRESPONDENCE: Vedran Pašara, Klinički bolnički centar Zagreb, Kišpatićeva 12, HR-10000 Zagreb, Croatia. / Phone: +385-91-7302-512 / E-mail: vedran.pasara@gmail.comORCID:  Vedran Pašara, https://orcid.org/0000-0002-6587-2315 • Lucija Lučev, https://orcid.org/0000-0003-0247-099XVlatko Šulentić, https://orcid.org/0000-0002-3675-7633 • Andreja Bujan Kovač, https://orcid.org/0000-0003-3729-8624Romana Perković, https://orcid.org/0000-0002-1958-3096 • Daniel Lovrić, https://orcid.org/0000-0002-5052-6559RECEIVED: November 4, 2022ACCEPTED: November 10, 2022Introduction: Contrast-induced encephalopathy (CIE) is a rare neurological complication of the intra-vascular administration of iodinated contrast agent in angiographic procedures. Patients with CIE can experience various neurological deficits that usually occur shortly after the administration of iodinated contrast agent and resolve spontaneously within 48 hours1,2.Case report: 75-year-old male patient who received a heart transplant 13 years before the event and had undergone a total of eleven coronary angiographies and five percutaneous coronary interven-tions (PCI) due to cardiac allograft vasculopathy (CAV), was admitted for a regular follow-up. Coro-nary angiography followed by right coronary artery PCI with two drug-eluting stents implantation was performed during this hospital stay. An iodinated contrast agent was used. The patient received unfractionated heparin during the procedure. Two hours later the patient was found sitting on the bed, head and eye deviated on the left, unresponsive with oroalimentary and gestural automatisms. Both pupils were equal. There was no facial asymmetry or lateralization. A head computed tomography (CT) scan was performed immediately and showed no signs of acute ischemia, hemorrhage, or focal intrac-ranial process. Levetiracetam was introduced due to a suspected seizure. The cranial CT follow-up on the next day showed no abnormalities. Electroencephalography (EEG) revealed diffuse dysrhythmic changes with the focal slowing on the right frontotemporal and left frontocentrotemporal region, and paroxysmal discharges of high voltage low-frequency delta activity (encephalopathic pattern). There-fore, levetiracetam was continued. The patient was discharged on the fifth day oriented, responsive, and without speech impairment. Three months later, EEG showed a mild slowing in the right fronto-centrotemporal and left frontotemporal regions.Conclusion: CIE is a rare complication of cardiac catheterization, probably underrecognized and un-derdiagnosed. However, it should not be overlooked, and invasive cardiologists should be aware of this condition.LITERATURE1. Spina R, Simon N, Markus R, Muller DW, Kathir K. Recurrent contrast-induced encephalopathy following coronary angiography. Intern Med J. 2017 Feb;47(2):221-224. https://doi.org/10.1111/imj.133212. Cristaldi PMF, Polistena A, Patassini M, de Laurentis C, Giussani C, Remida P. Contrast-induced encephalopathy and permanent neurological deficit: A case report and literature review. Surg Neurol Int. 2021 Jun 14;12:273. https://doi.org/10.25259/SNI_44_2021

Contrast-induced encephalopathy after coronary angiography in a heart transplant recipient: a case report

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Contrast-induced encephalopathy after coronary angiography in a heart transplant recipient: a case report

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