SESSION TITLE: Cardiovascular Cases I
SESSION TYPE: Medical Student/Resident Case Report
PRESENTED ON: Sunday, October 27, 2013 at 07:30 AM - 08:30 AM
INTRODUCTION: Venous Thromboembolism is a common medical condition that is most frequently treated with anticoagulation. However, patients with contraindications to anticoagulation, have failed anticoagulation therapy, or have developed life-threatening bleeding from anticoagulation require IVC filter placement. There are also several proposed indications for IVC filter placement. However, although significant advancement has been made in IVC filer placement by interventional radiology, there has been a vast amount of literature regarding immediate and long-term potential complications. One of the feared life-threatening immediate complications of IVC filter placement is complete migration to the heart, with risk for cardiac arrhythmia, cardiac tamponade, and death. More recently, delayed complications of IVC filters have been reported, including filter strut fracture and migration to the heart, now another possible cause of cardiac tamponade.
CASE PRESENTATION: We present a case of a 77 year-old female with a history of Asthma on chronic steroids, Pulmonary Embolism secondary to sedentary lifestyle with history of IVC filter placement 3 years prior to admission, and severe pulmonary hypertension secondary to chronic thromboembolic disease who presented with obstructive shock due to cardiac tamponade requiring Dopamine drip. Imaging with Chest CT and Echocardiogram revealed IVC filter strut fracture and migration to the right ventricle with penetration of the free wall causing cardiac tamponade. She underwent successful percutaneous retrieval by Interventional Radiology with subsequent resolution of chest pain, dyspnea, and hemodynamic instability.
DISCUSSION: Cardiac tamponade has been reported in the literature as a potential immediate and long-term complication of IVC filter placement. There have only been 3 other cases in the literature in which this occurred months to years after placement. This is also the first reported case in which the filter strut that fractured and perforated through the right ventricle was successfully removed percutaneously, thus limiting patient morbidity and length-of-stay.
CONCLUSIONS: Although considered a relatively safe procedure, IVC filter placement is associated with many potential complications. We present this case for the judicious use of IVC filters and the prevention of unnecessary filter placement given the known complications with associated morbidity and mortality.
Reference #1: Rogers NA et al. Fracture and embolization of an inferior vena cava filter strut leading to cardiac tamponade. Circulation 2009; 119:2535-2536.
Reference #2: Chandra PA et al. Cardiac tamponade caused by fracture and migration of inferior vena cava filter. South Med J 2008; 101:1163-1164.
DISCLOSURE: The following authors have nothing to disclose: Mina Makaryus, Sandeep Mehrishi, Arunabh Talwar
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