2024 Volume 28 Issue 1 Pages 103-106
A 56-year-old man with acute myocardial infarction underwent emergency coronary artery bypass graft surgery. Following the induction of general anesthesia, a central venous catheter was inserted via the right internal jugular vein under ultrasound guidance. Resistance was encountered during guidewire removal, prompting the use of transesophageal echocardiography, which revealed entanglement of the guidewire tip with the Eustachian valve. Attempts to straighten and untangle the guidewire using a longer dilator were unsuccessful. Considering the potential risk of cardiac structure damage, the open-chest procedure was performed, allowing for direct visualization and successful removal of the guidewire.
When encountering catheter entanglement within the right atrium, the normal structures, such as the tricuspid valve, and the presence of embryonic remnants should be considered for an accurate differential diagnosis. Transesophageal echocardiography serves as a valuable diagnostic tool in identifying this condition. In catheter removal procedures, minimally invasive techniques should be initially employed. If unsuccessful, owing to the potential risk of injury, removal should be attempted in the operating room under the supervision of cardiac surgeons.
