Critical Care: Student/Resident Case Report Poster - Critical Care I |

A Fatal Migration: A Case of Intra-Cardiac Embolization of a Peripheral Stent FREE TO VIEW

Xuan Gao, MD; Navitha Ramesh, MD; Jaime Deseda, MD; Janvi Paralkar, MD; Serena Fox, MD
Author and Funding Information

Mount Sinai Beth Israel, New York, NY

Copyright 2016, American College of Chest Physicians. All Rights Reserved.

Chest. 2016;150(4_S):373A. doi:10.1016/j.chest.2016.08.386
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SESSION TITLE: Student/Resident Case Report Poster - Critical Care I

SESSION TYPE: Student/Resident Case Report Poster

PRESENTED ON: Tuesday, October 25, 2016 at 01:30 PM - 02:30 PM

INTRODUCTION: Intravascular device migration and intrusion into the cardiac chambers is an extremely rare yet potentially lethal complication, often recognized late due to the low clinical suspicion. While an inferior vena cava (IVC) filter migration into the heart has been commonly described, the literature on peripheral stent embolization into the heart is limited. We present a patient in profound shock state, in whom point of care ultrasound revealed IVC stent in the right atrium.

CASE PRESENTATION: A 55-year-old female with diabetes mellitus and peripheral vascular disease presented after a syncopal episode. Hours prior, she noted worsening shortness of breath and non-exertional chest pain, culminating in a syncopal episode. On presentation, the patient was minimally responsive and profoundly hypotensive with MAP<45mmHg. Initial electrocardiogram showed diffuse ST depression with new right bundle branch block. She was intubated and a central line was placed for vasopressor administration. On point of care ultrasound at the bedside, a rounded echo dense structure was seen in the right atrium in the sub-costal view. She immediately underwent a CT angiogram, which demonstrated the presence of an IVC stent in the right atrium. Before the arrival of the cardiothoracic surgery team, patient’s clinical state declined rapidly, leading to her demise. Upon further questioning, her daughter mentioned, that, about ten hours prior to presentation, patient had stent placement in the supra-renal IVC, common iliac vein, and bilateral iliac veins due to her symptomatic vascular disease, and was discharged home for recovery.

DISCUSSION: The diagnosis of stent migration hinges on high clinical suspicion and imaging with emergent echocardiogram or CT. It is unclear what triggered the migration of the device, but surgical or endovascular retrieval appear to be the primary treatment, albeit our patient was hemodynamically unstable to tolerate such interventions.

CONCLUSIONS: The placement of peripheral stents in management of severe vascular disease is a frequent occurrence. Additional clinical focus needs to be placed on the management of peripheral stent embolization, as it is a potentially fatal phenomenon.

Reference #1: Toyoda, N., Torregrossa, G., Itagaki, S., Pawale, A., & Reddy, R. (2014). Intracardiac Migration of Vena Caval Stent: Decision-Making and Treatment Considerations. J Card Surg Journal of Cardiac Surgery, 29(3), 320-322.

Reference #2: Owens, C. A., Bui, J. T., Knuttinen, M., Gaba, R. C., Carrillo, T. C., Hoefling, N., & Layden-Almer, J. E. (2009). Intracardiac Migration of Inferior Vena Cava Filters. Chest, 136(3), 877-887.

DISCLOSURE: The following authors have nothing to disclose: Xuan Gao, Navitha Ramesh, Jaime Deseda, Janvi Paralkar, Serena Fox

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