PMC4774947_01
A linogram demonstrating catheter fracture at the medial border of the first rib with extravasation of contrast material (single arrow). Contrast extends in the location of the innominate vein. The proximal portion of the catheter is located in the right atrium crossing into the right ventricle (double arrow).
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This demonstrated a catheter fracture at the first rib with extravasation of contrast at the site of insertion with the distal catheter fragment traversing the right atrium and the right ventricle with the tip within the right ventricular apex (Fig. 1).
Non-sustained ventricular tachycardia while catheter embolus was located in the right ventricle. The morphology changes as the catheter embolus moves through the right heart.
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Cardiac telemetry demonstrated non-sustained runs of both supraventricular as well as ventricular tachycardia (Fig. 2) as the catheter embolism migrated through his heart.
Subsequent cardiac catheterization demonstrating the catheter had migrated into the left pulmonary artery (A). A GooseNeck snare was placed over the distal end of the catheter embolus (B) and maneuvered through the right ventricle, inferior vena cava and femoral vein (C) where it was extracted. Examination of the removed catheter revealed thrombus (D).
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The patient was transferred to our catheterization laboratory where repeat fluoroscopy showed the distal catheter had embolized further into the left main pulmonary artery (Fig. 3A) with subsequent resolution of ventricular ectopy. Amplatz GooseNeck Snare Kit (Covidien, Plymoth, MN, USA) and withdrawn out of the pulmonary artery, into the right ventricle, then the inferior vena cava, and removed through the femoral sheath (Fig. 3C). The catheter fragment was found to have thrombus within its lumen (Fig. 3D).