PMC9845538_01
Fluoroscopic images. A: Fluoroscopic images of a spine entrapped in a mechanical valve. B: Advancing the ablation catheter toward the stuck disc and pushing on the hinge portion of the disc. C: Pushing a stuck disc using the shaft of the PentaRay catheter (Biosense Webster, Diamond Bar, CA). D: The mapping catheter was removed, but the spine sheared and strayed into the coronary artery. PA = posteroanterior view; RAO = right anterior oblique view.
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Fluoroscopic images revealed that 1 of the PentaRay spines was entrapped between the disc and the orifice ring, and the cover of the spine was torn and connected to the catheter body only by the metal wire (Figure 1A). We attempted to release the entrapped spine by advancing the ablation catheter toward the stuck disc with the support of the steerable sheath and pushing on the hinge portion of the disc with the catheter tip (Figure 1B, Supplemental Video 1). Next, we advanced the shaft of the PentaRay catheter toward the left ventricle (Figure 1C). Immediately thereafter, the entrapped catheter was extracted, but the wire was sheared off and the spine floated through the Valsalva sinus and strayed into the coronary artery (Figure 1D, Supplemental Videos 2 and 3).
Coronary angiography and recovery with snare. A, B: Coronary angiography showed that the spine was in the left circumflex artery. C, D: Successful capture of the spine using a 4 mm snare. CAUD = caudal; CRAN = cranial; LAO = left anterior oblique; RAO = right anterior oblique.
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Immediately thereafter, the entrapped catheter was extracted, but the wire was sheared off and the spine floated through the Valsalva sinus and strayed into the coronary artery (Figure 1D, Supplemental Videos 2 and 3). Coronary angiography via the right femoral artery showed that the spine was at the proximal segment of the left circumflex artery (LCx) (Figure 2A and 2B).
Recovered spine and PentaRay catheter (Biosense Webster, Diamond Bar, CA). One of the 5 spines was sheared near the root.
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Immediately thereafter, the entrapped catheter was extracted, but the wire was sheared off and the spine floated through the Valsalva sinus and strayed into the coronary artery (Figure 1D, Supplemental Videos 2 and 3). Figure 3).