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A: Preoperative 3-dimensional constructed enhanced computed tomography image. Seemingly no anatomic abnormality could be pointed out. On an in-depth look, the root of the small branch separated from the right inferior pulmonary vein (PV) ostium could be recognized (arrow);however, the tip of the branch was not visualized. The diameter of the small branch was 2.5 mm. B: Transverse computed tomography images before (left) and after (right) the ablation catheter entrapment. The catheter was positioned in the right inferior PV. However, it was unclear whether the catheter tip was positioned in a small branch of the PV or extracardiac area.
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Preprocedual echocardiography and enhanced computed tomography (CT) revealed no structural heart disease or anatomic anomalies (Figure 1A). The CT results showed that the catheter tip was positioned in a small branch of the PV or extracardiac area (Figure 1B). Subsequent analysis of CT results revealed that the root of the small branch separated from the right inferior PV ostium could be recognized; however, the tip of the branch was not visualized (Figure 1A).
Fluoroscopic image of the catheters. A: The ablation catheter entrapment site. B: The ablation catheter was pulled and inserted into the sheath. C: The ablation catheter and sheath were pulled to the maximum. These figures indicate the catheter had mobility of about 20 mm even after the catheter became entrapped.
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However, the catheter tip would not come free from the PV (Figure 2A-C).
A photograph taken during the surgery, from the head of the patient. The lower side is cranial and the upper side is caudal. Two suction tubes were in the right superior pulmonary vein (PV) and right inferior PV, respectively. The ablation catheter was entrapped in a small branch of the right inferior PV. The catheter tip was placed 15 mm distal to the RIPV ostium.
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According to the intraoperative findings, the catheter was entrapped in a small branch of the right inferior PV (RIPV) (Figure 3).