Disclosures: Ellen M. Farr, MD: Nothing to disclose

Case Description: At an outside facility, while admitted for stroke, the patient was noted to have episodic polymorphic VT on telemetry. During evaluation of this arrhythmia, the patient received a CT chest that did not show his IVC filter in his abdomen and instead showed a hyperdense material in his right heart. The hyperdense material was thought to be the IVC filter, which had migrated. Due to the surgical risks in the setting of recent hemorrhagic stroke, patient was transferred to inpatient rehabilitation for functional optimization and stroke rehabilitation prior to cardiothoracic surgery. During rehabilitation, patient underwent high intensity gait training, but was limited to a Borg RPE of 11-14 instead of the usual 15-17 given his risk of arrhythmia. He was closely monitored by his primary team and a consulting hospitalist for further arrhythmia and required temporary telemetry while he continued therapies. Upon discharge his overall FIM gain was 39 with a FIM efficiency of 0.6.

Setting: Academic inpatient rehabilitation facility

Patient: 44-year-old male with history of ischemic/hemorrhagic stroke complicated by DVT/PE requiring IVC filter.

Assessment/Results: Patient successfully underwent IVC filter removal, tricuspid valve ring annuloplasty, PFO closure, and additional acute inpatient rehabilitation without complication. During his second rehabilitation stay his overall FIM gain was 20 with a FIM efficiency of 1.17. He then returned home.

Discussion: IVC filters are a safe and well-established method to prevent DVT to PE progression in patients who cannot get therapeutic anticoagulation, however very few cases have been reported of IVC filter migration and the sequelae. This case highlights that while complications of IVC filters can be devastating, in the appropriate patient, prior rehabilitation in place of urgent removal may be best.

Conclusion: Migrated IVC filters are a rare occurrence. Our case highlights that with close monitoring during rehabilitation, functional optimization prior to cardiothoracic surgery can be safe and beneficial.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-broken-heart-safety-of-inpatient-rehabilitation-with-an-ivc-filter-embedded-in-the-heart/