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When Chemoport Short Circuited the Heart: A Case Report of Chemoport Induced Postoperative Refractory Arrhythmia
Ashish Bangaari1, Thavasimani Abirami2, Senthil Kumar Ravichander3
1Department of Liver Transplant Anaesthesia and Critical Care, MIOT International, Tamil Nadu, Chennai, India 600089.
Abstract:
Implantable chemoport (port-a-cath), a long-term venous access device for safe and sterile infusion of chemotherapeutic drugs, has improved cancer patients' quality of life with low complication rates. The ideal catheter tip positioning is above the pericardial reflection in the distal superior vena cava to decrease arrhythmogenic and thrombogenic complications. We report a case of an appropriately positioned chemoport catheter in a patient who underwent breast conserving surgery, causing new-onset postoperative paroxysmal rhythm disturbances leading to near-fatal syncope and sinus arrest. Postoperative rehabilitation directed at shoulder physiotherapy might have caused chemoport tip movement inducing endocardial irritation. We describe the dilemma and complexity of reasoning out the pathophysiology causing the nodal dysfunction, apart from sensitizing the readers about this under-appreciated complication.
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