Retrieval of a detached transseptal sheath tip from a right pulmonary artery branch following catheter ablation

Abstract

Transseptal introducer sheaths are being used with increasing frequency for left-sided arrhythmia ablations and structural heart disease interventions. Sheath tip detachment and embolization is an uncommon but known complication, and several sheaths have been recalled due to such complications. We report a unique case of a fractured transseptal sheath tip that embolized to a branch of the right pulmonary artery in a patient who had undergone ablation of a left-sided atypical atrial flutter. During final removal of one of the two long 8.5-French SL1 transseptal sheaths used routinely as part of the ablation, the radiopaque tip of the sheath fractured and first embolized to the right atrium and subsequently to a secondary right pulmonary artery branch. Using techniques derived from percutaneous interventional approaches, including a multipurpose catheter, coronary guidewire, and monorail angioplasty balloon, the sheath tip was successfully wired through its inner lumen, trapped from the inside with the balloon, and removed from the body via a large femoral vein sheath, without complications. The approach detailed in this case may guide future cases and circumvent urgent surgical intervention.

Successful Retrieval of a Dismembered Central Venous Catheter Stuck to the Right Pulmonary Artery Using a Stepwise Approach

“…We attempted this approach; however, it was technically difficult. Other options include bronchoscopic forceps, myocardial biopsy catheters, Fogarty catheters, hook guidewires [ 7 ], ablation catheters [ 8 ], and inflated coronary balloons [ 9 ]. Considering medical economics and safety, pigtail catheters are the most suitable, and they are familiar to all interventionists ( Table 1 ).…”