Kevin XXXXDOB: 11/21/XXXX
Kevin XXXX - Case Report
Parameter / FindingsDate of IVC Filter Placement / XX/XX/XXXX
Reason for IVC Filter Placement / Prophylaxis for Gastric LapBand Surgery to prevent embolic problems.
Procedure Name / NA.
Did the pre-image the vena cava to determine size and any anomalies? / NA
What was the size of the vena cava? / NA
Was placement done with fluoroscopic guidance? / Yes.
Did they confirm good placement with imaging? / Yes.
Was placement infrarenal? / Yes
Was patient told it was retrievable? / Yes (Per intake sheets)
Implant Details: / Bard’s Recovery IVC filter
Lot #:GFPDXXXX
Ref #:RXXXXX
Device Failure and Complications
Did one of the struts fracture? / No
Did the entire device migrate? Where? (Heart, Lungs) / Yes, the entire device migrated towards the heart (Right atrium)
Did the device tilt and have a strut(s) perforate the IVC? / The device was tilted during placement. The IVC fitter wires were visible as they had eroded through the right atrial wall near the inferior vena cava
Device Removal
Was the device removed in full? Open procedure? / Yes. Open procedure (Cardiopulmonary Bypass Surgery) on 04/30/XXXX
Failed Removal Attempt / No
If Yes, is patient put on lifetime anticoagulation? / Yes
If Yes, is patient now stuck with it for life? / No
MEDICAL SUMMARY
Client:Kevin XXXX
DOB:11/21/XXXX
Brief Case Summary:Kevin XXXX, 37-year-old malewith a history of pacemaker implanted, had a Bard’s Recovery IVC filter placed on 08/04/XXXXon the right femoral vein as a prophylaxis to prevent embolic problems. Due to his morbid obesity, he underwent LapBand gastric surgery on 08/17/XXXX. On 04/26/XXXX,hedeveloped chest pain and shortness of breath and went to ER and was diagnosed with large pulmonary emboli attached to the pacemaker wire. On 04/30/XXXX, fluoroscopy imaging showed migration of the filter to the right atrium. Subsequently, anemergentpulmonary thromboembolectomy,retrieval of migrated IVC filter, cardiopulmonary bypass (Open procedure) was performed and the filter was removed.
Past Medical History:Diabetes mellitus, lower extremity venous stasis, obstructive sleep apnea gastroesophageal reflux disease,pneumonia, Shortness of breath, morbid obesity, and pulmonaryembolism on Coumadin therapy.
Surgical History:Cardiac Pace maker (06/XXXX), IVC filter (XXXX), Gastric surgery in (XXXX).
Family History:Positive for hypertension, diabetes mellitus, dyslipidemia heart disease, gall bladder disease.Brother known hyper coagulopathy
Social History:Smokes 6-7 cigarettes per day, alcohol on occasion. Unmarried and works as a DJ and dances.
Allergy: Vicodin
DATE / PROVIDER / OCCURRENCE/TREATMENT / PDF REF07/07/XXXX / John Joseph, M.D. / Pre-operative Evaluation for IVC Filter placement:
HPI:Patient who wasasked to evaluate on behalf of Dr. Gensarfor evaluation for possible preoperative temporary inferior vena cava filter. The patient is being evaluated for a Lap Band procedure due to his morbid obesity.
Impression:
1. Morbid obesity with multiple medical problems as result of his obesity.
2. History of pulmonary embolism on coumadin therapy.
I recommended placement of a temporary inferior vena cava filter prior to the surgical intervention. / 423
08/04/XXXX / Saint Luke’s Regional Medical Center
John Joseph, M.D. / Operative report:
Pre & Post-operative Diagnosis: Morbid obesity, history of pulmonary embolus.
Anesthesia:Sedation/local
Procedure performed: Placement of temporary inferior vena cava filter. Venogram, inferior vena cava. Catheter placement, inferior vena cava.
Description of procedure: Using an ultrasound, an 18 gauge needle was inserted into the right common femoral vein and a J-wire was advanced into the inferior vena cava under direct fluoroscopic guidance. A 6 French sheath was placed in the inferior vena cava under direct ultrasound guidance over a wire. The inner dilator was removed, the catheter sheath was then brought down to the distal inferior vena cava and a venogram was performed, which documented the location of the renal veins and the confluence of the iliac veins. A recovery filter by Bard was advanced through the sheath into proper position at the L3 position and was deployed. A completion venogram demonstrated opposition of the catheter to the caval wall. There was a slight tilt within the inferior vena cava filter, but other than the slight tilt it was in satisfactory position. The sheath was removed and direct pressure was held on the right groin. There was good hemostasis. A band-aid was placed in the puncture site and the patient was taken to recovery.
Radiology report- Infrarenal IVC filter percutaneous placement
This procedure was performed in the hospital operating room. Therefore, to see the operative report for the results of any fluoroscopy or the interpretation of any imaging done in association with this procedure. / 59, 431, 465, 448
08/04/XXXX / Implant Details:
Filter vena cava
Description: Bard
Ref #: Rf048f
Lot #: GFPD4713 / 438-439
04/26/XXXX / Sridevi Narayan, M.D. / Echo report:
Indications: Pericardial Effusion And Chest Pain
Impression:Pacer wire seen in right ventricle. Appears to have large mass attached to pacer wire mostly within right atrium.Right ventricular systolic pressure is estimated to be 45rnmHg consistent with moderate pulmonary hypertension. No significant pericardial effusion. / 71-72
04/28/XXXX / Sridevi Narayan, M.D. / Transesophageal Echo report:
Impression:Echogenic mobile mass large extending from Right Atrium (RA) to Right Ventricle (RV) almost obstructing the Tricuspid Valve (TV).Pacer in Right Heart.Small pericardial effusion noted. / 73-75
04/29/XXXX / Robert M Witt, M.D. / CTAbdomen and Pelvis
Findings:There is a small pericardial effusion. The patient has a gastric Lap-Band in place. Accompanying tubing is noted extending out subcutaneously over the left anterior abdominal wall. IVC shows no evidence of any filter.The iliac and femoral vessels appear unremarkable. Small umbilical hernia with mesenteric fat is demonstrated. Degenerative changes are seen in the spine.
Impression:
1. There is pleural reaction in both lung bases with infiltrates, scarring oratelectasis present at the bases as well.
2. No IVC filter is demonstrated.
3. No definite venous thrombus is seen on this study. / 48-50
04/30/XXXX / Mark RWellness, M.D. / Chest Fluoroscopy-IVC filter migration
Impression:Inferior vena cava filter migrated to the right atrium. / 51-52
04/30/XXXX / Crown Health Center
Athan Ramona, M.D. / Surgical Consultation for emergent pulmonary embolectomy and retrieval of capsularis IVC filter:
HPI:The patient became acutely hemodynamically unstable and was transferred from telemetry to the coronary care unit.
Impression :
1. Migrated IVC filter into the heart.
Plan:I recommend that he undergo emergent pulmonary thromboembolectomy,retrieval of migrated IVC filter, cardiopulmonary bypass, possible circulatory arrest, andintraoperative transesophageal Echocardiography. / 92-94,250-252
04/30/XXXX / Crown Health Center
Athan Ramona, M.D. / Operative notes:
Procedure performed:Cardiopulmonary bypass, relief of pericardial tamponade, and evacuation of hemopericardium, removal of displaced IVC filter, right atrial thrombectomy, and intraoperative transesophageal Echocardiography.
Anesthesia : General endotracheal
Indications:The filter migrated into the right atrium and eroded the right atrial wall resulting in hemopericardium and pericardial tamponade.
Procedure:Intraoperative Transesophageal Echocardiography showed a large, dense thrombus and echogenic wires in the right atrium. An incision was made from the sternal notch to the xiphoid. The sternum was opened longitudinally with a sternal saw.Hemostasis was obtained with electrocautery and bone wax at the sternal edges. The patient was systemically heparinized. The pericardium was opened longitudinally and tented anterior with Ethibond stay stitches.
Approximately 800cc of dark blood was evacuated from the pericardial cavity. The heart was covered with a fibrinous exudate. The IVC fitter wires were visible as they had eroded through the right atrial wall near the inferior vena cava. The aortic cannula was inserted first followed by superior and inferior vena caval cannulas. An antegrade cardioplegic cannula was placed in the ascending aorta. Cardiopulmonary bypass was instituted. The aorta was crossclamped and the patient was given 900cc of cold cardioplegia in an antegrade fashion. There was prompt cardiac arrest/ice was placed on the heart for further myocardial protection. A phrenic nerve protector pad was used. The superior vena cava and inferior vena cava were occluded around the cannulas. A right atriotomy was performed. The inferior vena cava filter and organized thrombus were removed. Some more thrombus was removed from the pacemaker wire. The right atrial wall perforations were repaired with #5-0 Prolene stitches in a Figure-of-eight fashion. The right atrial incision was closed in 2 layers using #5-0 Prolene sutures. / 89-91,160,232
05/08/XXXX / Crown Health Center / Discharge Summary
Discharge diagnoses
1. Bilateral pulmonary embolism with right lower extremity deep venous thrombosis on admission
2. IVC filter displaced: Hemopericardium: Cardiac tamponade status post removalof displaced IVC, right arteriotomy and right thrombectomy and relief of pericardial tamponade on 04/30/10.
3. Hypercoagulable state with elevated homocysteine.
4. History of second-degree block Mobitz II status post pacemaker placement in XXXX.
Discharged: Home / 237-239;
1 of 4