Clinical & Experimental Cardiology
Open Access
ISSN: 2155-9880
+44 1300 500008
ISSN: 2155-9880
+44 1300 500008
Abdallah M Almaghraby
University of Alexandria, Egypt
Posters & Accepted Abstracts: J Clin Exp Cardiology
Introduction: Central venous catheterization (CVC) is a routine technique done in critical care and emergency departments for monitoring patients and giving certain parenteral medications in special conditions. Most common complications associated with CVCs are infection, hematoma, hemothorax, pneumothorax and superior or inferior vena cava trauma while rare complications include cardiac arrhythmias, air embolism and loss of the guide wire. We are reporting a case of unrecognized loss of CVC guide wire that caused a very rare unexplained cardiac complication. Case report: A 50-year-old male patient with no previous medical history presented to our hospital complaining of high grade fever with gradual onset and stationary course with no response to antipyretics and antibiotics for 1 week. Work-up for fever was unremarkable, mild renal impairment was accidentally diagnosed with Creatinine level of 2.8 mg/dl, fever subsided after giving intravenous antibiotics for 3 days then the patient developed hypotension, blood pressure was 70/40 mmHg, heart rate was 140 beats per minute, electrocardiogram showed sinus tachycardia, liver enzymes were elevated, serum bicarbonate level was very low so the intensive care specialist inserted a central venous catheter to guide his fluid status control, central venous pressure was very low so he received intravenous fluids together with the antibiotics. Chest X-ray was done a day later after central venous catheter insertion and astonishingly we found the introducing guide wire left inside his heart starting from the right internal jugular vein towards the right atrium and ventricle making a loop inside the pulmonary artery then down through the inferior vena cava towards the hepatic vein. The lost wire was retrieved blindly without fluoroscopic guidance and follow-up X-ray showed no residual wire parts, then he was referred to us for echocardiography and we found severe tricuspid valve regurgitation with no signs of chronicity with perforation of the anterior leaflet, no visible vegetations or thrombi, right and left ventricular systolic and diastolic functions were completely normal and no pericardial effusion. Two days later the patient was referred to us again for follow up as he was still hypotensive with elevated central venous pressure. The new echocardiography revealed severely reduced left ventricular systolic function with borderline dimensions and reduced right ventricular systolic function with normal dimensions. Discussion: To our knowledge, this is the first reported case of Tricuspid valve perforation and regurgitation after CVC insertion and lost guide wire. Also by reviewing the available literature, there is no known explanation for the development of heart failure in this reported case.
Email: dr.maghraby@gmail.com