Successful snare retrieval of a fractured transseptal sheath from the left atrium

A 60-year-old patient undergoing atrial fibrillation ablation underwent transseptal puncture using an 8.5-F non-steerable transseptal sheath (SL-1). Marked resistance was encountered while crossing the interatrial septum; however, left atrial access was eventually obtained with difficulty. For exchange to a steerable sheath, a .025″ spring guidewire was advanced through the SL-1 and looped within the left atrium. Fluoroscopic imaging demonstrated fracture of the distal portion of the SL-1 positioned over the looped wire. During initial snare attempts, the fragment disengaged from the guidewire and freely embolized within the left atrium. The SL-1 was subsequently exchanged for a steerable sheath, and the snare was re-advanced. The fragment was successfully captured, withdrawn into the steerable sheath, and the entire system was removed as a single unit. Although retrieval of such highly mobile intracardiac structures using a standard vascular snare is considered technically challenging, this case demonstrates that effective removal can be achieved with conventional techniques.