Retained Left Atrial Catheter: A Case Report and Review of the Literature

Incidental detection of a retained left atrial catheter via intraoperative transesophageal echocardiography in a patient undergoing tricuspid valve replacement: A case report

RATIONALE

A cardiac foreign body can cause thrombosis or infection, but sometimes it may not cause any symptoms in a patient. The diagnosis is mainly performed using a radiological examination. Especially, ultrasound is useful not only for detecting the foreign body but also for hemodynamic findings. However, the disadvantage of ultrasound is that it cannot be used where shadows are generated because of poor permeability. The transesophageal echocardiography (TEE) is superior to transthoracic echocardiography (TTE) for identifying posterior cardiac structures because the probe is located in the esophagus behind the heart. Here, we report on the incidental finding of a foreign body in the left atrium through TEE during cardiac surgery. It did not cause any symptoms or signs for 20 years.

PATIENT CONCERNS

A 75-year-old female patient with severe tricuspid regurgitation underwent tricuspid valve replacement (TVR) under general anesthesia. She had a history of mitral valve replacement (MVR) and tricuspid annuloplasty surgery 20 years ago.

DIAGNOSIS

A hyper-echoic floating intracardiac foreign body was observed in the left atrium during TEE examination. It was not detected in the preoperative imaging studies such as X-ray, computed tomography, TTE.

INTERVENTIONS

The cardiac foreign body found using TEE was visually confirmed through an incision in the left atrium. A long and thin foreign body was located in the right upper pulmonary vein to the left atrium, which was considered to be a left atrial catheter used during the MVR surgery performed 20 years ago. After removing the foreign body, the planned TVR operation proceeded.

OUTCOMES

After removing the intracardiac foreign body and TVR, the patient was admitted into the intensive care unit followed by the general ward as planned, and discharged without any complications.

LESSONS

TEE was very useful for diagnosing a foreign body in the posterior part of the heart. TEE performed during the perioperative period should be performed beyond the level of re-confirming the findings of TEE performed prior to surgery. If a retained catheter is detected, it may be appropriate to remove it considering the risk of complications.

Iatrogenic retained foreign body in the right atrium. Lessons to Learn

INTRODUCTION

We report a case of a retained foreign body in the right atrium and the review of the literature discussing several cases where the poor attention and management of medical staff has led to worsening consequences to patient's health.

PRESENTATION OF CASE

In our case the mass demonstrated on MRI scan turned out to be an inflammatory process and organized clotted blood built around a broken piece of a plastic cannula protruding out of the right atrium. This caused debilitating pleuritic pain to the patient on presentation.

DISCUSSION

The cause of this iatrogenic retained piece of cannula may well be from the patients prior diagnostic investigations.

CONCLUSION

Algorithm managed indications for surgical removal of such foreign bodies in symptomatic patients lead to better patient's outcomes and decreases the chances of infection, embolization, or erosions within the heart. Keeping this in view, we managed our patient with success.