Nakata Yuki, Ishiguchi Hironori, Fukuda Masakazu, Okamura Takayuki, Sano Motoaki
Division of Cardiology, Department of Medicine and Clinical Science, Yamaguchi University Graduate School of Medicine, 1-1-1 Minamikogushi, Ube, Yamaguchi 755-8505, Japan.
Eur Heart J Case Rep. 2025 Jul 18;9(8):ytaf345. doi: 10.1093/ehjcr/ytaf345. eCollection 2025 Aug.
Implantable central venous catheters are routinely used to maintain venous access. While generally safe, they can lead to unique complications such as pinch-off syndrome, where the catheter fractures due to mechanical stress. Typically, detached fragments migrate to the right atrium or pulmonary artery, but migration into the coronary sinus is extremely rare and challenging to manage.
A 50-year-old woman with a history of breast cancer and an implanted central venous catheter presented with chest discomfort. Imaging of fluoroscopy and cardiac computed tomography revealed a fractured catheter with a fragment migrating into the coronary sinus, extending straightly through the tricuspid valve to the right ventricular free wall. Initial retrieval attempts were unsuccessful due to the misalignment with the snare's direction of advancement and the fragment's vigorous movement. A second procedure using advanced techniques, including the wire-loop and double snare methods, successfully retrieved the entire fragment.
Percutaneous retrieval of catheter fragments that have migrated into the coronary sinus can be particularly challenging, especially when the fragment has limited capturable portions. In our case, the fragment's minimal exposure outside the sinus, its linear orientation towards the right ventricular free wall, and its vigorous synchronous movement with the wall made retrieval difficult, requiring advanced techniques. This report highlights a challenging case of fragment retrieval from the coronary sinus following pinch-off syndrome and underscores that preprocedural computed tomography can provide crucial information for predicting and planning for such complex interventions.
可植入式中心静脉导管常用于维持静脉通路。虽然一般来说是安全的，但它们可能导致一些独特的并发症，如夹闭综合征，即导管因机械应力而断裂。通常情况下，分离的碎片会迁移至右心房或肺动脉，但迁移至冠状窦极为罕见且处理起来具有挑战性。
一名50岁有乳腺癌病史且植入了中心静脉导管的女性出现胸部不适。荧光透视和心脏计算机断层扫描成像显示导管断裂，有一个碎片迁移至冠状窦，直接穿过三尖瓣延伸至右心室游离壁。由于与圈套器推进方向不对齐以及碎片剧烈移动，最初的取出尝试未成功。第二次手术采用了包括钢丝圈和双圈套器方法在内的先进技术，成功取出了整个碎片。
经皮取出迁移至冠状窦的导管碎片可能特别具有挑战性，尤其是当碎片可捕捉部分有限时。在我们的病例中，碎片在窦外的暴露极少，其朝向右心室游离壁的线性方向，以及与心室壁的剧烈同步移动使得取出困难，需要先进技术。本报告强调了夹闭综合征后从冠状窦取出碎片的一个具有挑战性的病例，并强调术前计算机断层扫描可为预测和规划此类复杂干预提供关键信息。
