Fracture of the Port Catheter and Migration Into the Coronary Sinus: Case Report and Brief Review of the Literature

Abstract

Introduction: Totally implantable venous device has a good safety profile, although certain complications may occur. Late mechanical complications include catheter fracture and cardiac migration which are rarely occurring in approximately 0.1% to 1% of patients.

Case presentation: A 33-year-old woman referred by the surgical oncologist for port catheter fragment extraction through endovascular approach. She was asymptomatic on presentation and has a history of hypertension and smoking. Chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae (right heart catheterization showed that the port catheter fragment was in the coronary sinus). Angiography of the right outflow tract indicates that the fragment was not in the outflow tract or pulmonary arteries but posterior to it. It was concluded that the port catheter fragment had migrated deep into the coronary sinus and the snare was unable to pull the fragment. It was deemed unfeasible to remove the fragment through the endovascular approach.

Discussion: The port catheter fracture had migrated entirely into the coronary sinus and to the deep of our knowledge; this was the fourth case reported in the current literature. We tried to do a review of previous similar case reports; interestingly, this was the only case where the fragmented catheter was situated deep within the coronary sinus without any part of the fragment projected to the right atrium. This made the retrieval of the fragment much more difficult with a high chance of failure.

Conclusions: Migration of totally implantable venous device into coronary sinus is a rare but possible complication and might be difficult to remove if the position is unfavorable.

Keywords: coronary sinus; fracture; migration; port catheter; totally implantable venous device.

Figure 1.

Postero-anterior chest X-ray showed a port catheter fragment previously thought to be in the right atrium at the level of 8-9 thoracic vertebrae.

Figure 2.

Port catheter fragment was visualized upon right heart catheterization. (A and B) Angiography of the right atrium and ventricle. (C) Fragment was posterior to the right ventricular outflow tract and pulmonary trunk. These indicate that the position of the port catheter fragment was within coronary sinus.

Figure 3.

Echocardiography was suggestive that the port catheter fragment had migrated into the coronary sinus.