Entrapment of central venous catheter by a suture to the left atrial wall following double valve replacement

Abstract

A 19-year-old female with severe mitral stenosis, moderate mitral regurgitation and severe aortic regurgitation was scheduled for double valve replacement. After a successful procedure, resistance was met on central venous catheter withdrawal on the third post-operative day. Fluoroscopy confirmed the fixation of catheter at the heart. This necessitated reopening the chest, cutting the left atrial wall suture, and removing the catheter. We believe that our case was one of the very few reports of central venous catheter sutured surgically to the wall of the left atrium and necessitated re-exploration of the chest to remove it. Inadvertent entrapment of central venous catheter by a suture in a fairly routine cardiac surgical procedure is a possible complication. Cardiovascular anesthesiologists and surgeons should take measures to prevent such a complication after every open heart procedure. Any irrational measures such as excessive traction to pull it out could be fatal. Cautious handling is advocated whenever an entrapped central venous catheter is found. Checking the catheter for possible entrapment by gently pulling it a few centimeters at the time of atrial wall closure and using a shorter length catheter may be strategies to prevent such a complication.