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[Transluminal extraction of intracardiac embolized catheter fragments in children]
1Abteilung Pädiatrische Kardiologie, Universität Freiburg.
Insights
Fragment embolization from central venous catheters, particularly in children with ventriculovenous shunts, requires mandatory extraction. Retrieval from the heart and pulmonary artery was successfully achieved using various catheter-based techniques.
Area of Science:
- Pediatric Cardiology
- Interventional Radiology
- Biomedical Engineering
Context:
- Central venous catheters and ventriculovenous shunts are frequently used in pediatric patients.
- Catheter fragment embolization is a known complication, posing significant risks.
- Timely intervention is crucial to prevent severe patient outcomes.
Purpose:
- To describe the successful retrieval of embolized catheter fragments from the central circulation in pediatric patients.
- To evaluate the efficacy of minimally invasive, catheter-based techniques for fragment extraction.
- To highlight the importance of prompt intervention for catheter-related emboli.
Summary:
- Five pediatric patients (1.8–7.8 years) with embolized catheter fragments in the right heart and pulmonary artery underwent successful retrieval.
- Techniques employed included loop snares, helical baskets, and myocardial biopsy catheters.
- Fragments originated from ventriculoatrial shunts or advanced central silastic catheters; adhesions complicated extraction in two cases.
Impact:
- Demonstrates the feasibility and safety of percutaneous fragment retrieval in challenging pediatric cases.
- Minimally invasive extraction reduces the need for open-heart surgery.
- Highlights the potential for advanced interventional tools to manage catheter-related complications effectively.
Abstract:
The frequent use of central venous catheters for administration of fluids and especially ventriculovenous shunts in children sometimes lead to embolisations of catheter fragments. Because of the potential complications, extraction of the fragments is mandatory. In 5 children aged 1.8 to 7.8 years fragments were removed from the right heart and the pulmonary artery by use of a loop snare, a helical basket or a myocardial biopsy catheter. In four cases the fragment was the distal part of a ventriculoatrial shunt, in one case the central part of a silastic catheter had accidentally advanced into the pulmonary artery. In two cases adhesions of the fragment to the wall of the pulmonary artery impeded the extraction.