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DOI: 10.1055/s-0032-1332709
Right heart failure caused by lost central venous catheter 28 years ago. A case report
Introduction: A 45-year-old woman was referred for investigation because of dyspnoe on exertion. 28 years earlier she received a central venous line via the right subclavian vein for the treatment of Ebstein-Barr virus infection. The central part of the catheter was accidentally left in place; the next 25 years were uneventful.
Aims: Echocardiography revealed signs of beginning right heart failure with dilation of the vena cava and the hepatic veins. MR imaging revealed interaction of the anterior tricuspid leaflet with the distal part of the central catheter. Right heart catheterization showed calcification adherent to the catheter. Simultaneous recording of right atrial and ventricular pressures demonstrated tricuspid stenosis with a mean pressure gradient of 5 mmHg. Since MRI demonstrated adhesion of the proximal part of the catheter with the subclavian vein and adhesion of the distal part with the tricuspid valve no interventional approach to rescue the catheter was performed.
Fig. 1: Intraoperative situs (catheter affiliated to valve)
Discussion: Intraoperatively subvalvular obstruction caused by the intratrabecular part of the anterior venous line (figure 1) in conjunction with severe subvalvular myocardial trabeculation was detected. After removal of the central line the right ventricular trabeculation had to be divided generously in order to place an adequate bioprothesis. The patient could be discharged at day 9 after surgery without any problems.