A Race Against Time: Endovascular Removal of an Intracardiac Foreign Body

Endovascular foreign body fragmentation, migration, and embolization to the right heart is a rare and late complication of the central venous port systems. The MediPort (Bard Medsystems, Reading, Massachusetts, USA) device consists of a port chamber attached to a central catheter implanted into the central venous system and used in patients with cancer for the administration of chemotherapy, parenteral nutrition, or blood transfusions. Interval radiologic survey, both intraoperatively and post-procedure, is crucial for investigating the possibility of both early and late complications, such as fracture and migration of the catheter, and for planning intervention. We detail a case of a 51-year-old woman with a background of estrogen receptor-positive invasive ductal carcinoma of the left breast, status post lumpectomy, neoadjuvant chemotherapy via right subclavian vein MediPort, and beam radiation. She presented for the removal of the MediPort device following completion of chemotherapy. However, intraoperatively, the catheter was noted to be 9 cm shorter in length, with an irregular tip, appearing incomplete from the original length, indicating fragmentation. Chest X-ray demonstrated a fractured catheter approximately 9 cm in length coursing from the right atrium to the right ventricle from its original tip at the distal superior vena cava. Vascular surgery emergently completed intracardiac foreign body retrieval from the right heart using the Bard 30 mm loop snare catheter system successfully.