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IMAGES  
Year : 2014  |  Volume : 7  |  Issue : 3  |  Page : 233-235
Novel kissing catheter technique for foreign body retrieval


Department of Cardiology, Seth G. S. Medical College and King Edward Memorial Hospital, Mumbai, Maharashtra, India

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Date of Web Publication16-Sep-2014
 

   Abstract 

We report a novel technique 'the kissing catheter technique' for retrieval of a broken catheter fragment in a patient undergoing closure of a patent ductus arteriosus.

Keywords: Foreign body retrieval, gooseneck snare, novel kissing catheter technique

How to cite this article:
Jaiswal VR, Lanjewar CP, Phadke MS, Kerkar PG. Novel kissing catheter technique for foreign body retrieval. Ann Pediatr Card 2014;7:233-5

How to cite this URL:
Jaiswal VR, Lanjewar CP, Phadke MS, Kerkar PG. Novel kissing catheter technique for foreign body retrieval. Ann Pediatr Card [serial online] 2014 [cited 2019 Sep 15];7:233-5. Available from: http://www.annalspc.com/text.asp?2014/7/3/233/140865



   Introduction Top


Transcatheter retrieval of foreign body remains a challenging task. [1],[2] Various devices are being used including dormia baskets, snares, and tip-deflecting wires. [3],[4],[5] The introduction of gooseneck snares has simplified transcatheter retrieval of foreign body. Some situations continue to be challenging and innovations and improvisations have to be made on the spot. [6],[7] We used a novel technique called 'Kissing catheter technique' for retrieval of a broken catheter tip.


   Case report Top


The patient was a 1-year-old male child with history of recurrent respiratory tract infections. Echocardiogram (ECG) showed a 3.5 mm patent ductus arteriosus with continuous flow with peak systolic gradient of 70 mm Hg.

Aortogram revealed a type E duct (Krichenko Classification) [8] [Figure 1], hence a decision of PDA coil closure was taken. A 6F JR 3.5 was used to cross the duct. During crossing of the duct over the wire, proximal tip of the catheter broke and was stuck into the duct at the pulmonary artery end. The proximal end of catheter was stuck to the anterior right ventricle (RV) wall [Figure 2]. We attempted to retrieve this with a standard routine approach with a 10 mm gooseneck snare. After multiple attempts, we could not succeed. The impinging of the proximal end of broken catheter against the RV anterior free wall prevented looping of catheter with the snare. We also unsuccessfully tried to dislodge the broken catheter from the RV end by whipping it with a 4F Pigtail catheter. Considering the anatomy, and as the pulmonary arterial end of the duct was holding the catheter, we decided to cross the catheter from the aortic end to make an atrio-ventricular (AV) loop and then capture (monorail) arteriovenous loop with the snare over the wire [Figure 2] and [Figure 3] and Video 1]. A 4F JR 3.5 was passed through right femoral artery over 035 exchange length straight tip Terumo guidewire. After ensuring that both the tip of broken catheter and 4F JR 3.5 were facing each other the 035 exchange length straight tip terumo was probed into the tip of the broken catheter and brought down in the RV. Through a 10 mm snare this Terumo guidewire was exteriorised out through right femoral vein (RFV) forming an AV loop [Video 2].

The snare was mono-railed and the broken catheter tip was grabbed and snared out of RFV [Figure 4] and [Figure 5]. Subsequently, PDA was closed with 052" Gianturco coil. Post procedure aortogram showed no residual shunt [Figure 6].
Figure 1: Showing patent ductus arteriosus type E

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Figure 2: Shows the kissing catheter technique (arrow) i.e. broken catheter tip was probed from the aoric end with an exchange length straight tip terumo wire

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Figure 3: Broken catheter tip was probed from the aortic end with an exchange length straight tip terumo wire which is seen in RV

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Figure 4: Showing terumo wire being exteriorised with a snare through right femoral vein forming an AV loop

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Figure 5: Broken catheter tip snared through right femoral vein by monorailing the snare on the AV loop

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Figure 6: Shows 052" gianturco coil in situ with no residual shunt

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   Discussion Top


We postulate that the reason behind breaking of catheter could be, first, a complex anatomical subset of the duct where the distal end of the catheter got stuck at the narrow pulmonary artery end. Secondly the application of inappropriate force and rotation resulted in breaking of the catheter. The distal end facing the aortic lumen was relatively immobile which enabled the kissing and advancing a straight tip guidewire. While we recognize that such instances, where one end of broken catheter is immobile would be rare in clinical practice, this report illustrates a useful improvisation to enable safe retrieval.

 
   References Top

1.Uflacker R, Lima S, Melichar AC. Intravascular foreign bodies: Percutaneous retrieval. Radiology 1986;160:731-5.  Back to cited text no. 1
[PUBMED]    
2.Liu JC, Tseng HS, Chen CY, Chern MS, Chang CY. Percutaneousretrieval of 20 centrally dislodged Port-A catheterfragments. Clin Imaging 2004;28:223-9.  Back to cited text no. 2
    
3.Dotter CT, Ro¨sch J, Bilbao MK. Transluminal extraction of catheter and guide fragments from the heart and great vessels; 29 collected cases. Am J Roentgenol Radium Ther Nucl Med 1971;111:467-72.  Back to cited text no. 3
    
4.Egglin TK, Dickey KW, Rosenblatt M, Pollak JS. Retrieval of intravascular foreign bodies: Experience in 32 cases. AJR Am J Roentgenol 1995;164:1259-64.  Back to cited text no. 4
    
5.Curry JL. Recovery of detached intravascular catheter or guidewire fragments: A proposed method. Am J Roentgenol Radium Ther Nucl Med 1969;105:894-6.  Back to cited text no. 5
[PUBMED]    
6.Yedlicka JW Jr, Carson JE, Hunter DW, Castan˜eda-Zu´n˜iga WR, Amplatz K. Nitinol gooseneck snare for removal of foreign bodies: Experimental study and clinical evaluation. Radiology 1991;178:691-3.  Back to cited text no. 6
    
7.Cekirge S, Weiss JP, Foster RG, Neiman HL, McLean GK. Percutaneous retrieval of foreign bodies: Experience with thenitinol goose neck snare. J Vasc Interv Radiol 1993;4:805-10.  Back to cited text no. 7
    
8.Krichenko A, Benson LN, Burrows P, Moes CA, McLaughlin P, Freedon RM. Angiographic classification of the isolated, persistently patent ductus arteriosus and implications for percutaneous catheter occlusion. Am J Cardiol 1989;63:877-9.  Back to cited text no. 8
    

Top
Correspondence Address:
Vinay R Jaiswal
Department of Cardiology, Seth G. S. Medical College and King Edward Memorial Hospital, Dr. Ernst Borges Road, Parel, Mumbai - 400 012, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0974-2069.140865

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4], [Figure 5], [Figure 6]



 

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