Perforation of the Heart During Elective Removal of an Inferior Vena Cava Filter

Area of Science:

• Cardiology
• Vascular Surgery
• Medical Device Safety

Background:

• Inferior vena cava (IVC) filters are used to prevent pulmonary embolism in patients with venous thromboembolic disease who cannot receive anticoagulation.
• Temporary IVC filters offer a solution to mitigate long-term risks associated with permanent filter placement.
• Filter retrieval is a common procedure, but potential complications exist.

Observation:

• A patient undergoing elective IVC filter removal experienced cardiac arrest during the procedure.
• The retrieval involved an intravascular approach from the right jugular vein, with difficulties encountered during sheath manipulation.
• The patient developed chest and neck discomfort, followed by hypotension, loss of consciousness, and death.

Findings:

• Autopsy revealed two cardiac perforations, one in each ventricle, and significant pericardial effusion.
• The IVC filter was found to be in place, with no hemorrhage noted around it.
• The cause of death was attributed to cardiac tamponade resulting from the perforations.

Implications:

• This is the first reported fatality linked to cardiac perforation by an access sheath during IVC filter removal.
• The case underscores the critical importance of meticulous technique and awareness of potential catastrophic complications during IVC filter retrieval.
• Highlights the need for vigilance and prompt recognition of adverse events during intravascular procedures.