Percutaneous Removal of Flexible Foreign Body from the Heart

Abstract

The complication of catheter embolization has been reported, and several technics have been designed for nonsurgical removal of such foreign bodies from the heart (1, 3, 4). In the case herein reported, a simple percutaneous approach toward removal of the catheter fragment is described. Case Report A 50-year-old psychiatric patient had a catheter fragment sheared off at the needle tip following right subclavian vein puncture for administration of medication. A chest radiograph revealed this fragment lying partially within 'the right ventricle with the other end in the superior vena cava. With the usual catheter materials in the X-ray Department, a simple snare-loop device was made. A 125-cm, 0.025-inch guide wire was passed through a white (opaque) P.E. catheter (0.037 inch I.D. × 0.054 O.D.). This in turn was passed through a 240 P.E. catheter 30 cm long, and the wire with the small P.E. cover was doubled back into the outside sleeve with the loop formed as indicated in Figure 1. The loop wire was then bent laterally so the plane would be about 90° to the end of the embolized catheter. With an outside sleeve of this size, enough space remained to pass the assembly over a 0.035-inch guide. Under local anesthesia the right internal jugular vein was then catheterized, employing the usual percutaneous technic for veins. Before passage of the assembly over the wire, the tract to and through the vein was dilated with 6-F and 8-F Teflon dilators. After removal of the 0.035inch guide, space was available to inject heparinized saline as necessary. A hemostat was used to hold one end of the doubled-back inside catheter and wire (Fig. 1); the other end could be played in and out of the sleeve to vary the loop diameter. With the loop open, passes of the entire assembly were made under fluoroscopic control from above downward for a short distance and then were rotated each time. When the embolized catheter moved with the rotation, both wire loop ends were drawn to close the loop around the foreign body, fold the end on itself, and recess it into the outer sleeve for security. The time required for removal was five minutes. Discussion It is generally agreed that foreign bodies in the heart cavities should be removed in order to eliminate them as a source of sepsis, thrombosis, and perforation (3). The above-described technic represents a simple approach for removal of flexible foreign bodies from the heart. There seems to be no reason why it could not be used for the removal of similar objects from larger arteries under certain circumstances. The internal jugular approach is the shortest and straightest route to the right heart, as opposed to the femoral vein (2) or the antecubital vein (1) approach, allowing greater loop control with no curves in the outside sleeve. This simple device is smaller and less rigid than those employed in other technics (1, 3,4).