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LETTERS TO EDITOR
Year : 2022  |  Volume : 16  |  Issue : 1  |  Page : 124-125

Migration of chemoport catheter to the right ventricle: A catastrophic rare complication


Department of Anesthesiology and Critical Care, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India

Correspondence Address:
Bharat Paliwal
All India Institute of Medical Sciences, Jodhpur - 342 005, Rajasthan
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sja.sja_460_21

Rights and Permissions
Date of Submission18-Jun-2021
Date of Decision25-Jun-2021
Date of Acceptance25-Jun-2021
Date of Web Publication04-Jan-2022
 


How to cite this article:
Goyal N, Kamal M, Paliwal B, Kumar R. Migration of chemoport catheter to the right ventricle: A catastrophic rare complication. Saudi J Anaesth 2022;16:124-5

How to cite this URL:
Goyal N, Kamal M, Paliwal B, Kumar R. Migration of chemoport catheter to the right ventricle: A catastrophic rare complication. Saudi J Anaesth [serial online] 2022 [cited 2022 Jan 19];16:124-5. Available from: https://www.saudija.org/text.asp?2022/16/1/124/334754



Sir,

A totally implantable venous device (TIVD), or chemoport, has revolutionized the delivery of chemotherapeutic agents in cancer patients by preventing multiple pricks and it also minimizes the risk of thrombophlebitis by chemotherapy cycles. Though TIVD has a good safety profile, catheter fracture and migration into cardiac chambers can occur in approximately 0.1–1% of the patients.[1] Foreign bodies in the heart are symptomatic in 56% of the patients. Around 20% of them have presented within the first 24 h while 30% of the patients have presented years after the penetration of the foreign body.[2] The clinical presentation differs from resistance to irrigation, localized pain or swelling, chest pain to lethal arrhythmia. Cardiac perforation, thrombosis, dysrhythmias, endocarditis are dreaded complications that require removal of the catheter urgently either through the endovascular or surgical route.[3]

A 3-year-old female child having B-cell acute lymphocytic leukemia presented with a history of severe chest pain and fever for 2 days. She had undergone a chemoport insertion 25 days back. The chest X-ray revealed that the chemoport catheter had dislodged and migrated into the right ventricle [Figure 1].
Figure 1: Preoperative chest X-ray of the child showing the fractured chemoport in the right ventricle.

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The child was posted for endovascular retrieval of the catheter under general anesthesia (GA). During the procedure, the catheter got surpassed into the pulmonary artery and could not be retrieved. The patient was shifted to the cardiothoracic operation theater (OT) on controlled mechanical ventilation.

In OT, American Society of Anesthesiologists standard and invasive blood pressure monitoring were continued. GA was maintained with sevoflurane and atracurium. The central venous catheter was accessed by the right internal jugular vein. The position of the migrated catheter was confirmed by a transesophageal (TEE) probe [Figure 2]a. One end of the catheter was present in the right ventricle while another end lied in the main pulmonary artery [Figure 2]b. With a backup preparation of emergency cardiopulmonary bypass (CPB), surgery was initiated. The pulmonary artery was exposed by midline sternotomy. The clamps were applied on the superior vena cava (SVC) and inferior vena cava (IVC) to stop venous return to the heart and the catheter was removed via a small incision on the pulmonary artery. The incision site was rapidly sutured and the clamp was released. The clamp on to clamp off time was 90 s. The blood pressure during the clamping was maintained with the vasopressor and inotropic agents. The complete removal of the migrated catheter was confirmed with TEE. The child was extubated after recovery. She was discharged on the fifth postoperative day.
Figure 2: (a and b): TEE image showing the catheter through the right ventricular outflow tract into the pulmonary artery.

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A majority of foreign bodies reached the heart by migration (88%) and the right heart chamber is the one occupied more often. The disconnection of the catheter from the chamber and migration to the right atrium, IVC, and SVC is also reported.[4] But serial migration of a chemoport catheter into the right ventricle and pulmonary artery has not been reported so far.

The anesthetic concerns are pertinent to further dislodgement of the catheter during induction of anesthesia, arrhythmias, embolism, and perforation of the heart chamber during removal of foreign body. The preparedness for rapid blood transfusion and for emergent CPB in case of life-threatening bleeding is the key for the management of such cases and can be challenging for an anesthetist.

Acknowledgment

The authors acknowledge the team effort involving cardiothoracic surgeons Dr Alok Kumar Sharma, Dr Surendra Patel and Dr Danishwar Meena along with the anesthesia junior resident Dr Sneha Vajanthri.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Lukito AA, Pranata R, Huang I, Thengker A, Wirawan M. Fracture of the port catheter and migration into the coronary sinus: Case report and brief review of the literature. Clin Med Insights Case Rep 2019;12:1179547619832282. doi: 10.1177/1179547619832282.  Back to cited text no. 1
    
2.
Leitman M, Vered Z. Foreign bodies in the heart. Echocardiography 2015;32:365-71.  Back to cited text no. 2
    
3.
Tabatabaie O, Kasumova GG, Eskander MF, Critchlow JF, Tawa NE, Tseng JF. Totally implantable venous access devices: A review of complications and management strategies. Am J Clin Oncol 2017;40:94-105.  Back to cited text no. 3
    
4.
Kapadia S, Parakh R, Grover T, Yadav A. Catheter fracture and cardiac migration of a totally implantable venous device. Indian J Cancer 2005;42:155-7.  Back to cited text no. 4
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