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Cardiac Perforation by Migrated Fractured Strut of Inferior Vena Cava Filter Mimicking Acute Coronary Syndrome
Chris W Piercecchi1, Julio C Vasquez2, Stephen J Kaplan3
1Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
Insights
A rare complication of inferior vena cava (IVC) filter placement occurred when a strut penetrated the right ventricle. Sternotomy was the safest retrieval method, preventing further migration or trauma.
Area of Science:
- Cardiology
- Interventional Radiology
- Cardiovascular Surgery
Background:
- Inferior vena cava (IVC) filters are used to prevent pulmonary embolism.
- Late complications, though rare, can occur after IVC filter placement.
- Embolization of IVC filter components is an infrequent but serious event.
Observation:
- A 52-year-old woman presented with chest pain due to an embolized IVC filter strut penetrating her right ventricle.
- Cardiac catheterization and echocardiography confirmed the diagnosis.
- Endovascular retrieval was deemed too risky due to the strut's location near the coronary artery and risk of pulmonary migration.
Findings:
- Urgent surgical removal of the IVC filter strut via sternotomy was successfully performed.
- The patient had an uneventful postoperative recovery and remained asymptomatic.
- This case highlights a unique complication not previously described for embolized filter fragments.
Implications:
- Traditional sternotomy is recommended for retrieving embolized IVC filter fragments to minimize risks.
- This approach ensures patient safety by preventing further migration or cardiac trauma.
- Further research into minimally invasive techniques for fragmented filter retrieval may be warranted but sternotomy remains the gold standard.
Abstract:
We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.
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