Pericardial Tamponade Caused by Perforation of Marshall Vein During Left Jugular Central Venous Catheterization

Abstract

Patient: Female, 62Final Diagnosis: Persistent vein of MarshallSymptoms: Chest discomfortMedication: —Clinical Procedure: —Specialty: CardiologyObjective:Congenital defects/diseasesBackground:The persistence of a vein of Marshall (VoM) from the left subclavian vein to the coronary sinus is a rare cardiac anomaly known as a persistent left superior vena cava (PLVC). This anatomical variant is usually asymptomatic but can lead to serious complications during catheterization via the left subclavian or internal jugular vein, as described here. In our case, the patent vein of Marshall directly connected the coronary sinus with the left subclavian vein discovered in a cardiac arrest patient because of pericardial effusion during the insertion of a central venous catheter (CVC).Case Report:A 62-year-old patient required a central line insertion through a left internal jugular vein. The patient immediately went into cardiac arrest after CVC insertion with a pericardial effusion. The patient was successfully resuscitated with the drainage of a pericardial effusion. A chest X-ray revealed that the central venous catheter (CVC) was located along the left border of the mediastinum rather than the right border. It was evident that the central venous catheter was inadvertently placed into the pericardial space, resulting in tamponade. This complication occurred through inadvertent access of a small persistent vein of Marshall.Conclusions:This case illustrates the importance of knowledge of anatomical variants of the persistent vein of Marshall to prevent or correctly interpret and manage procedural complications.

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.…”

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

“…The complication rate associated with central catheter insertion in children is 2.4–4.6% [ 1 ]. The CT incidence is quite variable, ranging from 0.0001 to 1.4% [ 2 , [10] , [11] , [12] ]. CT constitutes approximately 5% of all mechanical complications [ 4 , 17 ].…”

“…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.…”

“…The Hickman catheter (HC) affords many advantages, including application of intense therapy via lumina of different diameters if medications are incompatible and infusion of large fluid volumes. HCs are often inserted via the jugular or subclavian veins of pediatric patients [ [1] , [2] , [3] ]. However, HCs may be associated with various complications, one of which is cardiac tamponade (CT)-related cardiac perforation (CP) [ 4 ].…”

Intraoperative identification of persistent left superior vena cava with intracavitary electrocardiogram during venous port insertion: A report of eight cases

“…Although very rare, intraoperative complications like arterial puncture, mechanical damage to vessel wall, air embolism, and cardiac arrythmia cannot be obviated. Butt et al 40 reported a case of cardiac tamponade caused by mechanical damage of a CICC inserted into PLSVC. Kawasaki et al 41 reported a case of dialysis catheter-related venous thrombosis, which was developed 4 h after insertion.…”