Delayed open-heart operation to remove migrated intracardiac inferior vena cava stents in a living donor liver transplantation recipient: a case report

Abstract

Intracardiac migration of inferior vena cava (IVC) filter or stent is a rare but potentially fatal complication of endovascular venous device placement. There is no consensus whether migrated stents should be surgically removed by open cardiac surgery or retrieved by the percutaneous endovascular route and whether an intervention should be performed immediately or expectantly. Herein, we report a 39-year-old female who received emergent left lobe living donor liver transplantation (LDLT) owing to posthepatectomy liver failure. She underwent angioplasty for IVC stenosis 13 days after her LDLT during which time two IVC stents migrated into right antrum (RA). Because of acute kidney failure, she received perioperative continuous venous-venous hemofiltration. Owing to unstable hemodynamics and impaired liver graft function, an emergent open-heart operation or angiography to remove the migrated metallic stents in the RA was considered very high-risk. After recovery of liver graft and kidney function, she underwent an open-heart surgery to remove the intracardiac migrated IVC stents 40 days after the stent migration and recovered well. Our report is the first to show that a delayed open-heart operation for removal of migrated intracardial IVC stents can be an acceptable choice in selected LDLT recipients.

Keywords: IVC stenosis; delayed open-heart operation; intracardiac migration of IVC stent; living donor liver transplantation.

Fig. 1

Stenosis of outflow of liver graft and migrated intracardial inferior vena cava stents Fig. 1A: Stenosis at the anastomosis of inferior vena caca and hepatic vein of the liver graft (arrow) was diagnosed 13 days post-living donor liver transplantation. Fig. 1B: Both stents stayed at their final position at the junction of the right antrum and superior vena cava (arrow).

Fig. 2

The two migrated inferior vena caca Wallstents in the right atrium were removed 40 days after their migration.