Central venous catheter fragment in coronary sinus extending to right ventricular free wall: a case report.

Background: Implantable central venous catheters are routinely used to maintain venous access. While generally safe, they can lead to unique complications such as pinch-off syndrome, where the catheter fractures due to mechanical stress. Typically, detached fragments migrate to the right atrium or pulmonary artery, but migration into the coronary sinus is extremely rare and challenging to manage. Case summary: A 50-year-old woman with a history of breast cancer and an implanted central venous catheter presented with chest discomfort. Imaging of fluoroscopy and cardiac computed tomography revealed a fractured catheter with a fragment migrating into the coronary sinus, extending straightly through the tricuspid valve to the right ventricular free wall. Initial retrieval attempts were unsuccessful due to the misalignment with the snare's direction of advancement and the fragment's vigorous movement. A second procedure using advanced techniques, including the wire-loop and double snare methods, successfully retrieved the entire fragment. Discussion: Percutaneous retrieval of catheter fragments that have migrated into the coronary sinus can be particularly challenging, especially when the fragment has limited capturable portions. In our case, the fragment's minimal exposure outside the sinus, its linear orientation towards the right ventricular free wall, and its vigorous synchronous movement with the wall made retrieval difficult, requiring advanced techniques. This report highlights a challenging case of fragment retrieval from the coronary sinus following pinch-off syndrome and underscores that preprocedural computed tomography can provide crucial information for predicting and planning for such complex interventions.