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How should I treat an accidentally misplaced 8 Fr drainage catheter in the right ventricle?

*Corresponding author: Department of Coronary Heart Disease, Skane University Hospital, 22185 Lund, Sweden. E-mail: jharnek@aol.com PRESENTATION OF THE CASE A 76-year-old male with a previous MI, hypertension, hyperlipidaemia and asthma was admitted with atypical chest pain. At the admission cTnT was 2,096 ng/L and ECG without changes and 10 mm of symmetrical pericardial effusion was revealed at echocardiography. Thoracic CT excluded aortic dissection and also confirmed the pericardial fluid (Figure 1) beside 4 cm of pleural effusion. Twenty-four hours later echo was repeated due to low blood pressure and shortness of breath. It showed rapid progression of the pericardial effusion adding up to 25 mm in the pericardial sac with a mild systolic compression of the right atrium and right ventricle. Pericardiocentesis and coronary angiography followed immediately. Fluoroscopy-guided and echo-assisted drainage was performed from the subxyphoideal approach (Flexima 8 Fr; Boston Scientific, Natick, MA, USA). During the puncture and guidewire insertion no changes were detected on ECG. The procedure was continued with placement of the pigtail drainage catheter. Contrast injection and saline test were performed and demonstrated a misplaced intracavital position of the drainage catheter within the right ventricle. The pigtail catheter had to be removed, but wouldn’t the large hole inflicted in the right ventricle then continue to fill the epicardial space? CASE SUMMARY