Description of Event or Problem · 1
DURING A SCHEDULED LEFT HEART CATH IN A PATIENT WITH EXTENSIVE CORONARY DISEASE, THE BALLOON CATHETER SECTION SEPARATED AND REMAINED IN THE BODY OF THE PATIENT. THE 6 FR XB 3.5 GUIDE CATH WAS INSERTED OVER A WIRE AND USED TO CANNULATE THE LEFT MAIN CORONARY FOR SUPPORT. BMW WIRE WAS ADVANCED DOWN THE LEFT CCA AND PARKED INTO THE 2ND OBTUSE MARGINAL ARTERY FOR PROTECTION. THE 2.0X12 APEX BALLOON INSERTED OVER THE WIRE INTO THE 2ND OBTUSE MARGINAL ARTERY. AFTER DILATION EXCHANGED FOR 3.0X15 ANGIOSCULPT BALLOON WAS INSERTED AT THE BIFURCATION AND INFLATED TO 7 ATMOSPHERES. MULTIPLE SEQUENTIAL INFLATIONS WERE PERFORMED. SEVERE CALCIFICATION AT THE OSTIUM OF THE 2ND OBTUSE MARGINAL ARTERY. THIS DID NOT YIELD. A 3.0 X 15 FLEXTOME BALLOON WAS ATTEMPTED BUT WOULD NOT PASS. A HI-TORQUE EXTRA-SUPPORT WIRE WAS INSERTED AS A BUDDY WIRE DOWN THE 2ND OBTUSE MARGINAL ARTERY. THE 3.0 X 15 WAS THEN INSERTED OVER THE HI-TORQUE EXTRA-SUPPORT. HI-TORQUE EXTRA SUPPORT WAS ADVANCED TO THE BIFURCATION. DILATED TO 9 AND 11 ATMOSPHERES. AFTER DILATION WITH THE 3.0 X 15 FLEXTOME THE FLEXTOME WAS ATTEMPTED TO BE REMOVED. THERE WAS SEVERE STRAIN ON REMOVAL OF THE FLEXTOME. IT WAS ATTEMPTED TO BE ADVANCED FORWARD AND THIS WAS UNSUCCESSFUL. IN ATTEMPTING TO REMOVE THE FLEXTOME BALLOON THE GUIDE BECAME DEEP SEATED. THEREFORE, GRADUAL PRESSURE WAS TAKEN AND THERE WAS RUPTURE OF THE FLEXTOME BALLOON BETWEEN THE STENT DELIVERY DEVICE AND THE BALLOON SEGMENT. AFTER RUPTURE OF THE BALLOON THE 6.0 GUIDE WAS WALKED OUT GUIDE OVER THE WIRES AND A 7-FRENCH GUIDE WAS INSERTED AND USED TO CANNULATE THE LEFT MAIN. IT WAS ATTEMPTED TO TRY TO USE A SMALL SNARE TO CAPTURE THE DEVICE. ONLY HAD ACCESS TO A 120CM SNARE. UNSUCCESSFUL IN CAPTURING AS IT WOULD ONLY ACCESS THE OSTIUM OF THE LEFT MAIL. SURGICAL CONSULT WAS IMMEDIATELY CALLED. THE PATIENT DID BECOME BRADYCARDIC AND HAVE CHEST PAIN. NITROGLYCERIN WAS INCREASED. CHEST PAIN WAS WELL-CONTROLLED. NO ELECTROCARDIOGRAPHIC CHANGES. DUE TO BRADYCARDIA ACCESS WAS OBTAINED IN THE RIGHT COMMON FEMORAL VEIN. A TEMPORARY TRANSVENOUS PACEMAKER WAS INSERTED. INTRA-AORTIC COUNTER BALLOON PULSATION PUMP WAS INSERTED IN THE LEFT COMMON FEMORAL ARTERY FOR CARDIAC RELAXATION. AFTER DISCUSSION WITH CARDIOTHORACIC SURGERY THE INTERVENTIONALIST HAD ACCESS TO A LONGER SNARE TO PROVIDE RETRIEVAL OF THE DEVICE WITHOUT POSSIBLY HAVING TO UNDERGO SURGERY. THE CASE WAS DISCUSSED WITH THE FAMILY ANGIOGRAPHY REVEALED THERE WAS STILL FLOW ACCESSING THE DISTAL CIRCUMFLEX AND THE DISTAL 2ND OBTUSE MARGINAL ARTERY. PRIOR TO TRANSPORT GUIDE WAS REMOVED. WIRES AND SHEATHS WERE SUTURED IN PLACE. PATIENT WAS HEMODYNAMICALLY STABLE THROUGHOUT THE CASE. WAS GIVEN PROPHYLACTIC DOPAMINE AT A LOW DOSE AS WELL AS NITROGLYCERIN TO HELP WITH HIS SYMPTOMS. PATIENT WAS TRANSPORTED TO ANOTHER FACILITY AND HAD TO HAVE OPEN HEART SURGERY TO REMOVE THE FOREIGN BODY. PATIENT REMAINS IN ICU AT LAST KNOWN TIME.