Endovascular removal of intracardiac foreign bodies: a single-center experience

Abstract

Objective. To analyze the results of endovascular removal of intracardiac foreign bodies. Material and methods. We estimated the results of endovascular removal of intracardiac foreign bodies in 9 men aged 35—54 years between 2022 and 2024. Patients were examined according to standard protocol (clinical examination, anamnestic data, electrocardiography, echocardiography, chest X-ray, contrast-enhanced cardiac CT). Endovascular interventions were performed under local anesthesia mainly through femoral and/or jugular access using introducers 6—12 Fr. Results. The technical success rate was 89% (n=8). Three (37%) patients required conversion to open vascular access as soon as foreign body was delivered to the common femoral artery due to technical difficulties in removing large fragments exceeding maximum allowable diameter of endovascular instrument. In one (11%) patient, we preferred removal through sternotomy under cardiopulmonary bypass due to large foreign body and groggy grip by the loop, as well as risk of intraoperative cardioembolic complications. Topographic analysis revealed predominant location of foreign bodies in the right cardiac chambers, in particular, the right ventricle (44%) and right atrium (22%). This corresponds to anatomical features of blood flow and hemodynamics in the right heart, where turbulent flow contributes to fixation of fragments. Less often, foreign bodies were localized in the left heart (33%), and damage to the left ventricle was observed in 22% of cases. This required a special attention when planning access and choosing tools, especially regarding the risk of embolism. There was no in-hospital mortality, and 30-day survival rate was 100%. Conclusion. Endovascular removal of intracardiac foreign bodies is currently perspective in interventional cardiology. This approach demonstrates high efficiency with minimal invasiveness as evidenced by low percentage of intra- and postoperative complications, shorter hospital-stay and rapid rehabilitation.