Percutaneous Removal of Embolized Catheter via Patent Ductus Arteriosus in 800-g Premature Infant

We report a novel technique for percutaneous retrieval of an embolized umbilical arterial catheter lost within the aorta of a premature baby. Key steps include the following: immediate commencement of prostaglandin to maintain ductal patency; venous access with a 4-F sheath (sheath in femoral artery in an approximately 800-g patient is impossible, and alternatives are very high risk); careful traversal of right heart and prograde crossing of patent ductus arteriosus; small snare and 0.014-in wire inserted through the same 4-F catheter; snare wound around embolized line; wire directed through, then captured by snare (not typical lasso snare of line); finally, glide catheter, snare, wire, and captured line carefully pulled through the heart and into the 4-F prelude ideal sheath. Potential pitfalls include the following: heart perforation or damage to pulmonary and tricuspid valves, and instability during snare/retrieval. Nontraditional use of a microsnare and wire through the same 4-F catheter via prograde approach can be used to retrieve embolized lines in the aorta in very preterm infants.