Nonfatal cardiac perforation after central venous catheter insertion

Abstract

Cardiac tamponade caused by perforation of the cardiac wall is a rare complication related to central venous catheter (CVC) placement. A 71-year-old female with a previous history of moderate aortic stenosis and kidney transplantation was admitted to hospital due to global heart failure and worsening of allograft function. Intensified hemodialysis was commenced through a CVC placed in the right subclavian vein. Chest radiography revealed catheter tip in the right atrium and no signs of pneumothorax. Thorough diagnostics outruled immediate life-threatening conditions, such as myocardial infarction and pulmonary embolism. However, not previously seen, 2 cm thick pericardial effusion without repercussion on the blood flow was visualized during echocardiography, predominantly reclining the free surface of the right atrium, with fibrin scar tissue covering the epicardium – it was the spot of spontaneously recovered cardiac wall perforation. Follow-up echocardiogram performed before the discharge showed regression of the previously found pericardial effusion.

Potentially fatal atrium perforation due to right jugular vein catheterization recognized by venography: A case report

“…In abrupt clinical deterioration, failure to include cardiac and vascular wall perforations as differential diagnoses may result in severe clinical repercussions, including death. 10 , 11 , 12 , 13 Cardiac perforation after central venous catheter placement occurs at a low rate, but it is highly life‐threatening due to rapid bleeding, pericardial effusion, and cardiac tamponade. Complications related to cardiac perforation are usually followed by a rapid decline in the patient's condition and urge immediate action by the physicians.…”

“…The erosion of the myocardial wall due to catheter malposition, catheter migration, and direct trauma during CVC are hypothesized as contributing mechanisms to perforations. In abrupt clinical deterioration, failure to include cardiac and vascular wall perforations as differential diagnoses may result in severe clinical repercussions, including death 10–13 . Cardiac perforation after central venous catheter placement occurs at a low rate, but it is highly life‐threatening due to rapid bleeding, pericardial effusion, and cardiac tamponade.…”

Hickman catheter-induced cardiac tamponade-related cardiac perforation management by mediastinotomy in children and a review of the literature

“…CP caused by CT may be affected by the time of catheter insertion, movement of the catheter tip, angle of insertion, movement of the cardiac chambers, and direct trauma [ 5 ]. CP associated with central catheter placement features puncture of the cardiac wall, superior vena cava, or inferior vena cava by the guidewire, dilator, or catheter per se [ 2 , 6 , 11 , 14 , 20 ]. In our present case, the wound was located in the right atrium, as in many other cases.…”

“…Treatment is influenced by multiple factors such as the lesion size, hemodynamic effect, and etiology [ 16 ]. A small traumatic ventricular septum may close spontaneously, but an atrial defect may not [ 6 ]. Because our patient had an atrial defect, we scheduled surgery.…”

“…Complications associated with HC insertion are similar to those associated with other central catheters and include arterial puncture, CP, hemo-/pneumothorax, thrombosis, and infections [ 5 ]. The mechanical complication such as; vascular issues and CP are the most serious life-threatening complications after central venous catheter insertion [ 6 ].…”