Two cases of catheters inserted from the femoral vein straying into the hepatic vein, possibly owing to a Eustachian valve: a case report

• Published in: JA clinical reports 2022-07, Vol.8 (1), p.54-54, Article 54
• Main Authors: Takise, Yoshiaki, Maeda, Takuma, Yonezawa, Hiroki, Minami, Kimito, Morinaga, Masahiro, Ohnishi, Yoshihiko
• Format: Article
• Language: English
• Subjects: Anesthesiology; Blood tests; Case Report; Case reports; Catheters; Critical Care Medicine; Dogs; Emergency Medicine; Eustachian valve (EV); Extracorporeal membrane oxygenation; Extracorporeal membrane oxygenation (ECMO); General anesthesia; Heart surgery; Hepatic vein (HV); Intensive; Intensive care; Medicine; Medicine & Public Health; Minimally invasive cardiac surgery (MICS); Pain Medicine; Tomography; Veins & arteries
• ISSN: 2363-9024; 2363-9024
• DOI: 10.1186/s40981-022-00544-1

Background In minimally invasive cardiac surgery (MICS) and extracorporeal membrane oxygenation (ECMO), a guidewire is inserted from the femoral vein (FV) into the right atrium. However, rarely, the guidewire or catheter strays into the hepatic vein (HV) because of the inferior vena cava (IVC)-HV angle. We report two cases in which a guidewire and venous cannula from the FV strayed into the HV, likely owing to a Eustachian valve. Case presentation Both patients were women who underwent transesophageal echocardiography-guided FV cannulation. In case 1, a guidewire from the FV strayed into the HV owing to a Eustachian valve. In case 2, ECMO was established postoperatively. Transthoracic echocardiography confirmed the venous cannula had strayed into the HV. Computed tomography indicated IVC-HC angles of 129° (case 1) and 102° (case 2). Conclusion A Eustachian valve can impede devices inserted from the FV and even allow them to stray into the HV.