Tied up in the Lab: An Unexpected Catheter Knot in the Arterial System.
Anbhigya Kumar Arya, Anunay Gupta, Puneet Gupta et al.
✦ AI-curated · Sources linked
Case in brief
During transaortic mapping for ablation of premature ventricular complexes arising from the anterolateral papillary muscle, a ThermoCool SmartTouch catheter knotted in the arterial system after it was withdrawn into the ascending aorta and re-advanced. The catheter looped and its tip became entrapped; standard attempts to untie the knot failed. Operators cut the external catheter near the handle, advanced a large-bore 8.5 SL0 sheath over it, and used controlled contact against the aortic valve to loosen the knot and retrieve the sheath.
What made this case unusual
The knot was managed with a bailout technique involving a sheath advanced over the cut catheter and controlled mechanical contact with the aortic valve.
Diagnostic / clinical pearl
Recognize catheter looping or entrapment promptly during transaortic mapping; when standard maneuvers fail, this report describes sheath-assisted manipulation against the aortic valve to loosen the knot.