Cardiac Perforation by Migrated Fractured Strut of Inferior Vena Cava Filter Mimicking Acute Coronary Syndrome.
We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA. Electronic address: cpierc4@emory.edu.
Chris W
CW
Piercecchi
Division of Thoracic and Cardiovascular Surgery, Portneuf Medical Center, Pocatello, ID, USA.
Julio C
JC
Vasquez
Section of General, Thoracic, and Vascular Surgery, Virginia Mason Medical Center, Seattle, WA, USA.
Stephen J
SJ
Kaplan
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
Jordan
J
Hoffman
Division of Cardiothoracic Surgery, Emory University, Atlanta, GA, USA.
John D
JD
Puskas
Division of Thoracic and Cardiovascular Surgery, Portneuf Medical Center, Pocatello, ID, USA.
Jacob
J
DeLaRosa
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000601:surgery; D005260:Female; D006352:Heart Ventricles / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D000072663:Spontaneous Perforation / Q000175:diagnosis / Q000601:surgery; D016306:Vena Cava Filters / Q000009:adverse effects*
Device removal; Equipment failure; Foreign-body migration/complications/diagnosis/aetiology/surgery; Heart injuries