PMC3987453_01
Chest X - Ray Posterior - Anterior and Lateral Views Showing Dilated Main Pulmonary Artery and the Catheter
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Her chest x-ray revealed marked enlargement of the main pulmonary trunk with the catheter which appeared to lie in the left heart (Figure 1).
Echocardiogram Showing the Catheter Traversing the Interatrial Septum. Abbreviations: RA, Right Atrium; LA, Left Atrium
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Moreover, transthoracic echocardiography revealed severe pulmonary valve stenosis with Right Ventricular (RV) wall hypertrophy, peak systolic gradient of 76 mmHg across the Right Ventricular Outflow Tract (RVOT), the catheter traversing the interatrial septum (Figure 2), severe Tricuspid Regurgitation (TR), right ventricular dysfunction, mild pulmonary regurgitation, and normal left ventricular function.
Intraoperative Photograph of the Entrapped Catheter in the Interatrial Septum. Abbreviations: RA, Right Atrium; SVC, Superior Venacave; IVC, Inferior Venacave (Inset-extracted catheter tip)
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Under cardiopulmonary bypass and antegrade blood cardioplegic arrest, right atriotomy revealed that the catheter tip was entrapped within an area of fossa ovalis (Figure 3) away from a Patent Foramen Ovale (PFO).
Intraoperative Photograph of Domed, Stenosed Bicuspid Pulmonary Valve
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In addition, pulmonary arteriotomy showed (Figure 4) stenotic, bicuspid, thickened, and noncalcific pulmonary valve that allowed only Hegars dilator No. 16.