Author + information
- Received April 18, 2016
- Accepted April 22, 2016
- Published online July 25, 2016.
- Deepa Sasikumar, MD,
- Narayanan Namboodiri, MD∗ ( and )
- K.M. Krishnamoorthy, MD
- ↵∗Reprint requests and correspondence:
Dr. Narayanan Namboodiri, Department of Cardiology, SCTIMST, Trivandrum 695011, India.
A 1-year-old girl underwent catheterization prior to device closure of a large patent ductus arteriosus with pulmonary artery hypertension. The entry of the Goodale-Lubin catheter into the right ventricle was difficult and required excessive manipulations involving repetitive withdrawal and advancement of the catheter into the right atrium. After one such attempt, it was noted that the Goodale-Lubin catheter (Figure 1A, white arrow) had formed a knot in the right atrium (Figure 1A, black arrow). Gently pushing the catheter to loosen the knot was not successful, nor was it possible to pass a guidewire through the catheter (Figure 1B, white arrow), because the knot was very tight. After repeated attempts, we were able to pass a Terumo wire (Terumo Interventional Systems, Somerset, New Jersey) through the knot, and we then threaded a 5-F Judkins right catheter (Figure 1B, black arrow, Online Videos 1 and 2) over the wire and into the knot. We passed a superstiff exchange wire through the Judkins catheter and gently withdrew the Judkins catheter. We then passed a size 10 (length 2 cm) Tyshak balloon (B. Braun Interventional Systems, Chicago, Illinois) (Figure 1C, arrow, Online Video 3) over the superstiff wire and inflated it gently within the knot. As the balloon expanded, the knot loosened, and we were able to pass a guidewire (Figure 1D, arrow) through the Goodale-Lubin catheter, thus unfolding the knot (Figure 1E, Online Videos 4 and 5).
Knotting of a pulmonary artery flotation catheter is well described and has been ascribed to excessive looping and repetitive manipulations; it has been managed in various ways, including balloon inflation inside the knot, as in our case. Knotting of catheters other than flotation catheters is rare but can occur when the catheters are stressed beyond their operative design. The operator using the catheter should be well versed in techniques in managing complications related to catheters such as breakage and embolization, knotting, or entrapment. In all cases of catheterization, manipulation of catheters should be gentle and controlled to avoid complications.
For supplemental videos, please see the online version of this article.
All authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 18, 2016.
- Accepted April 22, 2016.
- American College of Cardiology Foundation