A rare case of foreign body in coronary sinus. A novel endovascular method for retrieval

Central venous catheter fracture and migration are rare complications in patients receiving long-term infusions or chemotherapy. We present a rare case of a chest port catheter fracture that migrated into the coronary sinus. This case is likely the fourth report of a port catheter fracture with migration to the coronary sinus. Because of the difficult-to-retrieve location, multiple attempts were unsuccessful with traditional techniques using a loop snare. Finally, the fractured portion was disengaged from the coronary sinus using a navigational electrophysiology catheter guided by intracardiac echocardiography; the dislodged end was snared and eventually removed by the femoral route. This case of a chest port catheter fracture is unique because of the unusual migration to the coronary sinus and the use of a navigational electrophysiology catheter as a novel retrieval technique

Utilization of Two- and Three-Dimensional Transesophageal Echocardiography in Successfully Guiding Transcatheter Mitral Valve in Bioprosthetic Mitral Valve/Mitral Ring Implantation without Complications in Patients with Thrombus in Left Atrium/Left Atrial Appendage

Background. The aim of this study is to describe, for the first time to our knowledge, the utilization of both two-dimensional (2D) and three-dimensional (3D) transesophageal echocardiography (TEE) in successfully performing transcatheter mitral valve (MV) in bioprosthetic MV/MV annulopasty ring implantation using the apical approach in 12 patients (pts) with co-existing left atrial appendage (LAA) and/or LA (left atrium) body thrombus, which is considered a contraindication for this procedure. Methods and Results. All pts were severely symptomatic with severe bioprosthetic MV stenosis/regurgitation except one with a previous MV annuloplasty ring and severe native MV stenosis. Thrombus in LAA and/or LA body was noted in all by 2D and 3DTEE. All were at high/prohibitive risk for redo operation and all refused surgery. Utilizing both 2D and 3DTEE, especially 3DTEE, guidewires and the prosthesis deployment system could be manipulated under direct vision into the LA avoiding any contact with the thrombus. The procedure was successful in all with amelioration of symptoms and no embolic or other complications over a mean follow-up of 21 months. Conclusion. Our study demonstrates the feasibility of successfully performing this procedure in pts with thrombus in LAA and/or LA body without any complications