Intracardiopulmonary Migration of an Inferior Vena Cava Filter and Concurrent Coronary Artery Disease: A Rare Surgical Challenge Publisher Pubmed



Gheydari ME ; Javankiani S ; Nasrollahizadeh A ; Nasrollahizadeh A
Source: Journal of Cardiothoracic Surgery Published:2025

Abstract

Introduction: Inferior vena cava (IVC) filters are widely used to prevent pulmonary embolism (PE), particularly in patients with contraindications to anticoagulation or those experiencing recurrent thromboembolism. Although rare, filter migration to the heart or pulmonary arteries, although rare, can result in life-threatening complications such as arrhythmias, valvular dysfunction, or perforation. Coronary artery disease (CAD) remains a major cause of morbidity and mortality, and its coexistence with a migrated IVC filter presents unique diagnostic and therapeutic challenges. We report a case of an IVC filter migrating to the right ventricular outflow tract and right pulmonary artery in a patient with significant left anterior descending (LAD) artery stenosis. Case presentation: A 65-year-old woman with a history of tongue carcinoma and pulmonary embolism managed with an IVC filter presented with atypical chest pain and exertional dyspnea. Imaging tests were ordered after an ECG and echocardiography revealed right heart strain. The mid-segment of the LAD has 80% stenosis, according to coronary angiography. A migrating IVC filter in the right pulmonary artery and RVOT was discovered by fluoroscopy. Given the risks associated with the filter’s location and the need for coronary revascularization, a multidisciplinary decision was made to perform surgical retrieval of the IVC filter alongside coronary artery bypass grafting (CABG). The surgery was successful, and the patient recovered well with no residual complications. Conclusion (clinical key message): IVC filter migration is a rare but serious complication that requires prompt recognition and intervention. This case underscores the importance of a multidisciplinary approach in managing complex cardiovascular conditions, particularly when surgical intervention is necessary for coexisting pathologies such as significant CAD. © 2025 Elsevier B.V., All rights reserved.