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Clin Med Insights Case Rep. 2019 Feb 27;12:1179547619832282. doi: 10.1177/1179547619832282. eCollection 2019.

Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature.

Author information

1
Department of Cardiology and Vascular Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.
2
Department of Internal Medicine, Siloam Hospitals Lippo Village - Faculty of Medicine, Universitas Pelita Harapan, Tangerang, Indonesia.

Abstract

Introduction:

Totally implantable venous device has a good safety profile, although certain complications may occur. Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients.

Case presentation:

A 33-year-old woman referred by the surgical oncologist for port catheter fragment extraction through endovascular approach. She was asymptomatic on presentation and has a history of hypertension and smoking. Chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae (right heart catheterization showed that the port catheter fragment was in the coronary sinus). Angiography of the right outflow tract indicates that the fragment was not in the outflow tract or pulmonary arteries but posterior to it. It was concluded that the port catheter fragment had migrated deep into the coronary sinus and the snare was unable to pull the fragment. It was deemed unfeasible to remove the fragment through the endovascular approach.

Discussion:

The port catheter fracture had migrated entirely into the coronary sinus and to the deep of our knowledge; this was the fourth case reported in the current literature. We tried to do a review of previous similar case reports; interestingly, this was the only case where the fragmented catheter was situated deep within the coronary sinus without any part of the fragment projected to the right atrium. This made the retrieval of the fragment much more difficult with a high chance of failure.

Conclusions:

Migration of totally implantable venous device into coronary sinus is a rare but possible complication and might be difficult to remove if the position is unfavorable.

KEYWORDS:

coronary sinus; fracture; migration; port catheter; totally implantable venous device

Conflict of interest statement

Declaration of conflicting interests:The author(s) declared the following potential conflicts of interest with respect to the research, authorship, and/or publication of this article: The authors have read and confirmed their agreement with the ICMJE authorship and conflict of interest criteria. The authors have also confirmed that this article is unique and not under consideration or published in any other publication.

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