J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 2 6 e3 2 7

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Images in Cardiovascular CT

Coil migration into coronary sinus: A rare complication of percutaneous transhepatic obliteration of portal systemic collaterals Hideki Kawai MD, PhD*, Yasuchika Kato MD, PhD, Sadako Motoyama MD, PhD, Masayoshi Sarai MD, PhD, Yukio Ozaki MD, PhD Department of Cardiology, Fujita Health University, 1-98 Dengakugakubo, Kutsukake-cho, Toyoake, Aichi 470-1192, Japan

article info

abstract

Article history:

A 62-year-old woman underwent percutaneous transhepatic obliteration of a giant portal-

Received 11 June 2013

systemic shunt. Just after inserting a coil into the shunt, it slipped through the giant shunt

Received in revised form

and migrated to the right atrium. CT showed coil migration into the coronary sinus.

3 August 2013

ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved.

Accepted 16 August 2013 Keywords: Computed tomography Coronary sinus Complication

A 62-year-old woman with cirrhosis had indications of percutaneous transhepatic obliteration of a giant portalsystemic shunt. Just after advancing a micro catheter to the lesion and inserting a coil into the shunt (Fig. 1A), the coil slipped through the giant shunt and migrated to the right atrium. After failing to remove it with a snare-loop catheter through the right internal jugular vein (Fig. 1B), she was referred to our hospital. CT showed coil migration into the coronary sinus (CS), maintenance of blood flow in CS, and circumferential pericardial effusion due to endocardial injury from the catheter procedure (Fig. 1CeE). Because of her poor prognosis and high risk of further invasive treatment as a result of hepatic encephalopathy and pancytopeniacomplicating cirrhosis, no further attempts at retrieval were made.

Causes of CS occlusion include thrombosis after cardiac surgery or trauma, vegetation due to infectious endocarditis, fungus ball of fungal infection, and complications due to deployment of CS leads.1 Right-sided foreign substances usually migrate to the pulmonary artery, less commonly to the right ventricle, and least commonly to the CS, but a few reports have found that acute occlusion of CS results in myocardial infarction2 or chronic occlusion in left ventricular dysfunction.3 The Thebesian valve, which prevents the regurgitation of blood into CS, was reported to be absent in 5% to 35% of human hearts, which may predispose to this complication. CT was a useful modality, although there was concern about using magnetic resonance imaging for a fresh coil.

Conflict of interest: The authors report no conflict of interest. * Corresponding author. E-mail address: [email protected] (H. Kawai). 1934-5925/$ e see front matter ª 2013 Society of Cardiovascular Computed Tomography. All rights reserved. http://dx.doi.org/10.1016/j.jcct.2013.08.014

J o u r n a l o f C a r d i o v a s c u l a r C o m p u t e d T o m o g r a p h y 7 ( 2 0 1 3 ) 3 2 6 e3 2 7

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Fig. 1 e Shown are the coil through the portal shunt (A) and the snare-loop catheter removing the coil migrating to the right atrium (B). CT showed coil migration into the coronary sinus and circumferential pericardial effusion (C), maintenance of blood flow in the coronary sinus (D).

references

1. de Voogt WG, Ruiter JH. Occlusion of the coronary sinus: a complication of resynchronisation therapy for severe heart failure. Europace. 2006;8:456e458.

2. Dabbah S, Reisner SA, Adler Z, et al. Intermittent coronary sinus occlusion complicating coronary sinus cannulation during coronary artery bypass operation. J Am Soc Echocardiogr. 2005;18:883. 3. Neri E, Tripodi A, Tucci E, et al. Dramatic improvement of LV function after coronary sinus thromboembolectomy. Ann Thorac Surg. 2000;70:961e963.

Coil migration into coronary sinus: a rare complication of percutaneous transhepatic obliteration of portal systemic collaterals.

A 62-year-old woman underwent percutaneous transhepatic obliteration of a giant portal-systemic shunt. Just after inserting a coil into the shunt, it ...
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