Positional Ventricular Tachycardia from a Fractured Mediport Catheter with Right Ventricular Migration

Abstract

The totally implantable catheter system has gained popularity as venous access when prolonged treatment is needed. Despite its frequent use, intravascular fracture and embolization of catheter fragments from implantable venous port-catheter systems present a rare but potentially life-threatening complication. Any implanted catheters should therefore be removed after completion of the treatment or the system's integrity should be monitored on a regular basis. This report illustrates such a case, which presented with ventricular tachycardia triggered by changes in body position from a fractured Mediport catheter with cardiac migration. A 34-year-old woman had a venous port catheter (Mediport) implanted into the right subclavian vein for neoadjuvant radio-chemotherapy for Hodgkin's lymphoma. Owing to the patient's difficult venous access the catheter was left in situ after treatment. Three years after insertion of the Mediport she presented with shortness of breath and palpitations when lying in the left lateral position. Physical examination revealed no abnormalities. An electrocardiogram was within normal rhythm. An outpatient Holter monitor revealed multiple episodes of nonsustained and sustained ventricular tachycardia triggered by lying in the left lateral position. A chest radiograph showed a normal location of the port-system, but the distal fragment of the catheter had embolized into the right ventricle. The embolized fragment was extracted with a gooseneck snare technique and the reservoir of the system was removed under local anesthesia without any complications. The patient was free of symptoms at 7 seven months follow-up.

Interventional radiological retrieval of embolized vascular access device fragments

“…However, current catheter embolism can still be associated with serious complications. Sudden death as a late complication of a catheter fragment embolism, a polymorphic ventricular tachycardia refractory to lidocaine treatment, and a ventricular tachycardia triggered by changes in body position from a catheter with cardiac migration have been reported (18)(19)(20). In our study, none of the patients presented with an arrhythmia or any other cardiological problems specific to embolism.…”

Totally implantable catheter migration and its percutaneous retrieval: case report and review of the literature

“…Some patients can show palpitations from ventricular tachycardia (3,38,39), thrombosis in the pulmonary artery (38), cough, dyspnea, thoracic pain (3), heart and vessel perforation, endocarditis, cardiac tamponade, cardiac arrest and even death (19). Mortality is reported in the Literature around 1.8% (40).…”

Wszczepialne systemy dostępu naczyniowego u chorych na nowotwory

“…Opóźnione zburzenia rytmu serca związane z obecnością cewnika wynikają z jego przemieszczenia, co może mieć miejsce w trakcie kaszlu, wymiotów czy wzrostu ciśnienia żylnego (na przykład w trakcie narastającej niewydolności serca). Opisywane były również przypadki śmiertelne, gdy fragment uszkodzonego cewnika przemieszczał się do prawej komory serca i wywoływał migotanie komór lub nagły zgon sercowy [27].…”