A drainage catheter tangled around a closed left atrial appendage
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A 70-year-old man underwent cardiac surgery including left atrial appendage closure. A pigtail catheter was inserted into the pericardial sac because of delayed tamponade. Removal of the catheter was planned for 2 days after drain insertion. However, the resistance was high and pulsatile. The patient was transferred to the catheterization laboratory and a guide wire was inserted through the catheter, revealing the catheter route around the left atrial appendage. The wire was exchanged for a stiff wire to uncurl the catheter as much as possible, then the catheter was removed. The left atrial appendage does not usually represent an obstacle to catheter removal because it is soft and shrinkable. However, once the left atrial appendage becomes closed off, it can become hard, unshrinkable and an obstacle that might be caught by the drainage catheter.
KeywordsLeft atrial appendage closure Drainage catheter Tamponade
After reports of the WATCHMAN atrial appendage closure device yielded favorable results for preventing cerebral infarction, concern about surgical left atrial appendage closure has increased [1, 2]. Herein, we report a case that serves as a warning about perioperative management after surgical left atrial appendage closure.
The catheter is seen going around the left atrial appendage. The normal left atrial appendage does not represent an obstacle to pulling out the catheter, because it is soft and shrinkable. However, closure can make the left atrial appendage hard and unshrinkable. Once the appendage becomes such an obstacle, the pigtail catheter can become tangled and catch on the appendage. It might happen even after the catheter-based closure. In this situation, a stiff wire is useful to uncurl the catheter and allow removal without strangling the left atrial appendage.
In cases such as the one described here, pulling forcefully on the catheter risks catastrophic consequences.
Compliance with ethical standards
Conflict of interest
The authors have no conflicts of interest to declare.
- 2.Boersma LV, Ince H, Kische S, Pokushalov E, Schmitz T, Shmidt B, et al. Efficacy and safety of left atrial appendage closure with WATCHMAN in patients with or without contraindication to oral anticoagulation: 1-year follow-up outcome data of the EWOLUTION trial. Heart Rhythm. 2017;14:1302–8.CrossRefGoogle Scholar
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