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Late Migration of a CardioMEMS TM Wireless Pulmonary Artery Hemodynamic Monitoring Sensor

2017; Lippincott Williams & Wilkins; Volume: 10; Issue: 4 Linguagem: Inglês

10.1161/circheartfailure.117.003948

1941-3297

Aniket S. Rali, Zubair Shah, Andrew J. Sauer, Kamal Gupta,

Non-Invasive Vital Sign Monitoring

HomeCirculation: Heart FailureVol. 10, No. 4Late Migration of a CardioMEMSTM Wireless Pulmonary Artery Hemodynamic Monitoring Sensor Free AccessCase ReportPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessCase ReportPDF/EPUBLate Migration of a CardioMEMSTM Wireless Pulmonary Artery Hemodynamic Monitoring Sensor Aniket S. Rali, MD, Zubair Shah, MD, Andrew Sauer, MD and Kamal Gupta, MD Aniket S. RaliAniket S. Rali From the Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City. , Zubair ShahZubair Shah From the Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City. , Andrew SauerAndrew Sauer From the Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City. and Kamal GuptaKamal Gupta From the Department of Cardiovascular Diseases, University of Kansas Medical Center, Kansas City. Originally published4 Apr 2017https://doi.org/10.1161/CIRCHEARTFAILURE.117.003948Circulation: Heart Failure. 2017;10:e003948IntroductionThe CardioMEMSTM heart failure (HF) system is an ambulatory pulmonary artery pressure monitoring system designed to help manage patients with difficult to control HF symptoms and to reduce the need for hospitalizations due to acute HF exacerbations. It is currently approved for use in patients with New York Heart Association class III symptoms and a previous hospitalization for congestive heart failure within the last year, regardless of ejection fraction.1,2 The entire system consists of a small pressure sensor (Figure 1) that is percutaneously placed in a branch pulmonary artery and can be remotely interrogated, in the hospital and at home, using a receiver.Download figureDownload PowerPointFigure 1. CardioMEMSTM Sensor. CardioMEMSTM and St. Jude Medical are trademarks of St. Jude Medical, LLC or its related companies. Reprinted with permission of the publisher. Copyright ©2017, St. Jude Medical.Available evidence within the literature indicates that the device implant is a safe process with no major complications being reported.1–4 The implant procedure is simple and involves a pulling thread that secures the tightly bound sensor to the delivery catheter. Once pulled, the nitinol loops on either end of the sensor spring open and secure the sensor into the branch pulmonary artery by their outward force. The loops are oversized in relation to the artery diameter by design to keep the sensor stable until endothelialization occurs. The loop diameter is 1 cm, whereas the recommended arterial diameter is 5 to 7 mm. In practice however, in many cases, the distal loop may be the only anchor as the proximal loop may be in an artery with a diameter bigger than the loop diameter. Because there is no secure anchoring mechanism (such as a hook or a barb), there is a possibility that even when deployed in an appropriate-sized artery, the sensor may migrate from the deployed position before endothelialization occurs. To the best of our knowledge, no cases of late device migration have been reported in published literature.In this report, we describe a case in which the sensor was deployed in an appropriate-sized artery but had a late migration after 4 months.Case ReportThe patient is a 70-year-old man with HF with preserved ejection fraction, New York Heart Association III HF symptoms, and history of multiple hospitalizations because of cute decompensated HF over the preceding year. He was referred by his HF team for placement of CardioMEMSTM sensor. In the catheterization laboratory, patient underwent right heart catheterization through right common femoral vein access. This was followed by angiography of the left lower lobe pulmonary artery to identify optimal position for device placement (Figure 2). CardioMEMSTM sensor was successfully deployed into a branch of the left pulmonary artery and placement confirmed under fluoroscopy (Figure 3). Good strength signals were obtained from the sensor post-deployment, and the sensor readings were used per our protocol to help manage his HF.Download figureDownload PowerPointFigure 2. Angiogram of left lung pulmonary artery branch.Download figureDownload PowerPointFigure 3. X-ray confirming sensor deployment into the left lung pulmonary artery branch.However, ≈4 months post-placement, we lost signal and no sensor readings could be obtained. A chest x-ray was done to confirm sensor position, and it showed that the sensor had migrated to the right lung (Figure 4). Once the sensor position was identified, we were again able to obtain readings by placing the wand over the new location.Download figureDownload PowerPointFigure 4. Chest x-ray confirming migration of the sensor into the right lung.DiscussionWe describe a previously unreported complication of late migration of the CardioMEMSTM sensor.Sensor migration is most likely to happen during the implant procedure especially if implanted in a less than ideal anatomy or if it jumps proximally during implant. However, the mechanisms of late implant migration are not as clear. Possible mechanisms could be placement in a larger than recommended pulmonary artery, a more horizontal rather than vertical orientation of the artery, or a more proximally located artery. None of these were true for this case. Other possible mechanisms could be related to the position in which the patient sleeps (risk of migration might be higher if patient sleeps in the right lateral position in case of a left-sided implant) or violent bouts of coughing, etc. Another interesting observation here was that the sensor actually migrated to the contralateral lung and did not fall back into the right ventricle. This is likely because of the direction of blood flow in the main pulmonary artery and is reassuring.In this patient, no adverse outcome occurred and the sensor continued to perform well in the migrated location. However, recognition of this possibility (even late after the implant) is important for several reasons. First, during informed consent, this should be discussed with the patient as it is possible that migration to an alternate location may result in device malfunction or worse complications if it migrates to the right ventricle. Second, if the sensor signals are lost, then the possibility of migration into the contralateral lung should be considered and a chest x-ray should be performed. Third, awareness of the possibility of sensor migration should further emphasize the importance of meticulous search for an appropriate-sized branch pulmonary artery to further decrease its chances of occurring.ConclusionsWe describe a case of late CardioMEMSTM sensor migration where the sensor moved from one lung to another after several months. This potential complication of the device has never been reported before.1–4 Although it did not cause any device malfunction in our patient, this certainly could be a serious complication that warrants thorough consideration during the device's placement and follow-up.DisclosuresNone.FootnotesCorrespondence to Kamal Gupta, MD, 3901 Rainbow Blvd, MS 3006, 1001 Eaton, Kansas City, KS 66160. E-mail [email protected]References1. Abraham WT, Adamson PB, Bourge RC, Aaron MF, Costanzo MR, Stevenson LW, Strickland W, Neelagaru S, Raval N, Krueger S, Weiner S, Shavelle D, Jeffries B, Yadav JS; CHAMPION Trial Study Group. Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial.Lancet. 2011; 377:658–666. doi: 10.1016/S0140-6736(11)60101-3.CrossrefMedlineGoogle Scholar2. Shavelle D, Jermyn R. The CardioMEMS heart failure sensor: a procedural guide for implanting physicians.J Invasive Cardiol. 2016; 28:273–279.MedlineGoogle Scholar3. Jermyn R, Alam A, Kvasic J, Saeed O, Jorde U. Hemodynamic-guided heart failure management using a wireless implantable sensor: infrastructure, methods, and results in a community heart failure disease-management program [published online ahead of print November 23, 2016].Clin Cardiol. 2016. doi: 10.1002/clc.22643.MedlineGoogle Scholar4. Abraham WT, Adamson PB, Hasan A, Bourge RC, Pamboukian SV, Aaron MF, Raval NY. Safety and accuracy of a wireless pulmonary artery pressure monitoring system in patients with heart failure.Am Heart J. 2011; 161:558–566. doi: 10.1016/j.ahj.2010.10.041.CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Ijaz S, Shah S and Majithia A (2021) Implantable devices for heart failure monitoring, Progress in Cardiovascular Diseases, 10.1016/j.pcad.2021.11.011, 69, (47-53), Online publication date: 1-Nov-2021. DeFilippis E, Kirtane A and Axsom K (2021) Troubleshooting CardioMEMS After Implant—Failure to Read, JAMA Cardiology, 10.1001/jamacardio.2021.1820, 6:9, (1090), Online publication date: 1-Sep-2021. Salavitabar A, Bradley E, Chisolm J, Hickey J, Boe B, Armstrong A, Daniels C and Berman D (2019) Implantable pulmonary artery pressure monitoring device in patients with palliated congenital heart disease: Technical considerations and procedural outcomes, Catheterization and Cardiovascular Interventions, 10.1002/ccd.28528, 95:2, (270-279), Online publication date: 1-Feb-2020. Brugts J, Radhoe S, Aydin D, Theuns D and Veenis J (2021) Clinical Update of the Latest Evidence for CardioMEMS Pulmonary Artery Pressure Monitoring in Patients with Chronic Heart Failure: A Promising System for Remote Heart Failure Care, Sensors, 10.3390/s21072335, 21:7, (2335) Deng F and Chonde D (2019) CardioMEMS device Radiopaedia.org, 10.53347/rID-70862 April 2017Vol 10, Issue 4 Advertisement Article InformationMetrics © 2017 American Heart Association, Inc.https://doi.org/10.1161/CIRCHEARTFAILURE.117.003948PMID: 28377440 Manuscript receivedFebruary 21, 2017Manuscript acceptedFebruary 28, 2017Originally publishedApril 4, 2017 Keywordsheart failurecardiac catheterizationheart ventriclesfluoroscopypulmonary arteryPDF download Advertisement SubjectsCardiomyopathyHeart Failure