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Jarnagin L, Shah A, Sagar AES. An 80-Year-Old Woman With Dyspnea and a Lung Mass. Chest 2023; 163:e79-e82. [PMID: 36759122 DOI: 10.1016/j.chest.2022.08.2223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 07/31/2022] [Accepted: 08/25/2022] [Indexed: 02/10/2023] Open
Abstract
CASE PRESENTATION An 84-year-old woman presented to the interventional pulmonary clinic for evaluation of a right middle lobe lung mass. Her medical history was notable for atrial fibrillation on rivaroxaban and recurrent bilateral breast cancer that had required multiple lumpectomies, radiation, and chemotherapy. She is a former smoker of five-pack years. She underwent a right and left heart catheterization at an outside facility 2 months prior to her presentation for evaluation of dyspnea that showed minimal coronary artery disease but elevated pulmonary artery pressures of 55/24 mm Hg. The procedure itself was complicated by hemoptysis that required hospital admission for observation. She underwent a chest radiography during her hospitalization (Fig 1) There was no recent imaging for comparison. She was seen by a pulmonologist as an outpatient and underwent bronchoscopy with BAL and bronchial brushing for concerns of malignancy. The results were not diagnostic. She was then referred to the interventional pulmonary service for further evaluation.
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Affiliation(s)
- Lisa Jarnagin
- Department of Pulmonary and Critical Care, Banner University Medical Center, Phoenix, AZ
| | - Archan Shah
- Department of Onco-Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ
| | - Ala-Eddin S Sagar
- Department of Onco-Medicine, Banner MD Anderson Cancer Center, Gilbert, AZ.
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2
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Jacobzon E, Hasin T, Lifschitz A, Bogot N, Farkash A, Tager S, Silberman S. Is There a Need for a Pulmonary Artery Catheter in Cardiac Surgery Today? Semin Cardiothorac Vasc Anesth 2020; 25:29-33. [PMID: 32847478 DOI: 10.1177/1089253220951322] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Pulmonary artery catheters are a useful tool for hemodynamic monitoring in high-risk patients during surgery and while in intensive care. However, there are major risks inherent to the device, and with modern day technology, their routine use has decreased. We discuss the need for routine insertion of pulmonary artery catheters in cardiac surgery. We also present a case of a left ventricular assist device implantation complicated by serious pulmonary hemorrhage due to pulmonary artery catheter insertion, highlighting the potentially life-threatening risks involved.
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Affiliation(s)
- Ehud Jacobzon
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Tal Hasin
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Avital Lifschitz
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Naama Bogot
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Adam Farkash
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Salis Tager
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Shuli Silberman
- Shaare Zedek Medical Center, Hebrew University of Jerusalem, Jerusalem, Israel
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Ono N, Nakahira J, Matsunami S, Sawai T, Minami T. Unexpected Collection of Pulmonary Venous Blood from a Pulmonary Artery Catheter: A Case Report. Anesth Pain Med 2017; 6:e42621. [PMID: 28975080 PMCID: PMC5560641 DOI: 10.5812/aapm.42621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 10/10/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pressure and waveform at the catheter tip are continuously monitored during catheterization of pulmonary artery to ensure accurate catheter placement. We present a case in which pulmonary venous blood was unexpectedly collected from the pulmonary artery catheter despite pulmonary artery pressure and waveform detection at the catheter tip, and describe the measures taken to correct the catheter placement. CASE PRESENTATION A 74-year-old male underwent mitral valve plasty for cardiac failure caused by mitral valve regurgitation. Preoperative transthoracic echocardiography showed no septal shunt. The pulmonary artery was catheterized through a sheath introducer in the right jugular vein, and the balloon was inflated after insertion of a 15-cm catheter. The catheter was advanced until a pulmonary artery waveform was detected and the pulmonary artery wedge pressure was 21 mmHg at end-expiration. The balloon was deflated and the catheter tip was pulled back 3 cm. Pulmonary artery waveforms and appropriate a and v waves were detected, and transesophageal echocardiography confirmed the location of the catheter tip in the right pulmonary artery. The first collected blood sample had an oxygen partial pressure of 358.8 mmHg, carbon dioxide partial pressure of 20.1 mmHg, and oxygen saturation of 99%, indicating pulmonary venous blood. The pulmonary artery catheter was pulled back 5 cm, but a second blood sample showed the same results. The catheter was pulled back a further 6 cm while the location of the catheter tip was monitored on X-ray fluoroscopy. Blood gas testing through the catheter tip showed oxygen saturation of 84.4 % and oxygen partial pressure of 41.6 mmHg. Surgery was performed uneventfully. Postoperative chest radiographs showed proper placement of the pulmonary artery catheter, but radiographs on postoperative day 1 showed over-insertion, although the insertion length was unchanged. The catheter was removed. The patient was discharged 2 months postoperatively. CONCLUSIONS Our case highlights the fact that the tip of the pulmonary artery catheter can easily advance into a peripheral branch of the pulmonary artery and cause pulmonary venous blood to be sampled instead of pulmonary arterial blood. A variety of monitoring techniques are needed to confirm accurate catheter placement.
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Affiliation(s)
- Naomi Ono
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan
| | - Junko Nakahira
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan
- Corresponding author: Junko Nakahira, Department of Anesthesiology, Osaka Medical College, 2-7 Daigaku-machi, Takatsuki, Osaka 569-8686, Japan. Tel: +81-726831221, Fax: +81-726846552, E-mail:
| | - Sayuri Matsunami
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan
| | - Toshiyuki Sawai
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan
| | - Toshiaki Minami
- Department of Anesthesiology, Osaka Medical College, Takatsuki, Japan
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L'Acqua C, Suriano P, Gregu S, Mazzanti V. Troubles After Swan-Ganz Catheter Placement in Cardiac Surgery. Semin Cardiothorac Vasc Anesth 2017; 21:262-265. [PMID: 28758561 DOI: 10.1177/1089253217699889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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5
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Pulmonary artery rupture as a complication of Swan-Ganz catheter application. Diagnosis and endovascular treatment: a single centre's experience. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2016; 12:135-9. [PMID: 27279873 PMCID: PMC4882386 DOI: 10.5114/aic.2016.59364] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Accepted: 08/19/2015] [Indexed: 11/25/2022] Open
Abstract
Introduction The placement of a Swan-Ganz catheter into the pulmonary artery may lead to a number of complications (2–17%). In less than 0.2% of cases Swan-Ganz catheterization results in serious vascular damage – pulmonary artery rupture (PAR). This paper presents two distinct forms of iatrogenic PAR treated endovascularly using different vascular devices. Aim To evaluate the effectiveness of endovascular treatment and the application of different types of vascular devices in the management of pulmonary artery rupture caused by Swan-Ganz catheterization. Material and methods In this retrospective study we evaluated 2 patients in whom Swan-Ganz catheter application was used for perioperative monitoring and resulted in pulmonary artery rupture. This complication was treated endovascularly by means of interventional cardiology. Results We report the cases of 2 patients with a pulmonary artery pseudoaneurysm formed in the perioperative period. In case 1, a single, 4-loop, 3 mm diameter coil was implanted. In case 2, a 5 mm Amplatzer Vascular Plug IV was applied. In both cases, the endovascular approach resulted in total occlusion of the feeding artery and reduced further extravasation of the blood. Conclusions Despite its extremely low incidence, iatrogenic PAR is a serious, life-threatening complication of Swan-Ganz catheterization that requires urgent attention. Among available methods of treatment, percutaneous embolization is a relatively quick, safe, accurate and highly effective alternative to traumatizing surgery.
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Sugiyama D, Ikeno S, Tsuchihashi T, Yokota S, Ina H, Kono T, Yamashita K, Kawamata M. Pulmonary alveolar hemorrhage from a pulmonary artery false aneurysm after Swan-Ganz catheterization in a thoracic aortic aneurysm patient: a case report. Korean J Anesthesiol 2014; 67:346-9. [PMID: 25473465 PMCID: PMC4252348 DOI: 10.4097/kjae.2014.67.5.346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Revised: 07/10/2013] [Accepted: 07/12/2013] [Indexed: 11/21/2022] Open
Abstract
Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.
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Affiliation(s)
- Daisuke Sugiyama
- Department of Anesthesia, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan. ; Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
| | - Shigeo Ikeno
- Department of Anesthesia, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Tetsuya Tsuchihashi
- Department of Anesthesia, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Shigeru Yokota
- Department of Anesthesia, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Hiroaki Ina
- Department of Anesthesia, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Tetsuya Kono
- Department of Cardiovascular Surgery, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Kunihiko Yamashita
- Department of Radiology, Japanese Red Cross Society of Suwa Hospital, Suwa, Japan
| | - Mikito Kawamata
- Department of Anesthesiology and Resuscitology, Shinshu University School of Medicine, Matsumoto, Japan
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7
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Endovascular treatment of PA pseudoaneurysm caused by Swan-Ganz catheter. ADVANCES IN INTERVENTIONAL CARDIOLOGY 2014; 10:66-70. [PMID: 24799935 PMCID: PMC4007305 DOI: 10.5114/pwki.2014.41476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2013] [Revised: 01/05/2014] [Accepted: 01/09/2014] [Indexed: 12/05/2022] Open
Abstract
The following case report describes a complication of Swan-Ganz catheterization and its endovascular treatment with a single coil. Application of this particular catheter in the pulmonary artery during cardiac surgery may lead to mechanical perforation and creation of an extravascular sac, which is called a pseudoaneurysm. There are different methods that lead to tamponade or closure of the leakage. Interventional cardiology procedures are nowadays the most appropriate way of treatment of Swan-Ganz catheter induced vascular complications.
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8
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Booth KL, Mercer-Smith G, McConkey C, Parissis H. Catheter-induced pulmonary artery rupture: haemodynamic compromise necessitates surgical repair. Interact Cardiovasc Thorac Surg 2012; 15:531-3. [PMID: 22718463 DOI: 10.1093/icvts/ivs287] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Pulmonary artery haemorrhage is thankfully a very rare complication following pulmonary artery catheter insertion. It carries a significant mortality of 50%, and most cases are managed conservatively or with embolization therapy. We present an occult case, in which a patient presented with haemodynamic compromise without haemoptysis or significant haemothorax, who required surgical intervention. We discuss surgical treatment management options and the need for a high index of clinical suspicion to prevent mortality from this condition.
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Affiliation(s)
- Karen Lynsey Booth
- Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.
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9
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Kalra A, Heitner S, Topalian S. Iatrogenic pulmonary artery rupture during Swan-Ganz catheter placement-A novel therapeutic approach. Catheter Cardiovasc Interv 2012; 81:57-9. [DOI: 10.1002/ccd.24392] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2011] [Accepted: 02/20/2012] [Indexed: 11/11/2022]
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10
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Shammaa ML, Hassan M, Bittar MN. Pulmonary artery catheter induced pulmonary haemorrhage. BMJ Case Rep 2009; 2009:bcr11.2008.1233. [PMID: 21754952 DOI: 10.1136/bcr.11.2008.1233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Since its introduction three decades ago, the pulmonary artery (PA) catheter has brought insights into pathophysiology of many diseases enabling intensivists to treat critical conditions much more precisely and securely. PA indications are widening, and those working in an intensive care environment feel more secure in handling critical conditions with objective data. However, PA-induced pulmonary haemorrhage is a well-recognised, uncommon, yet potentially lethal, complication of PA catheter. We report a case with PA haemorrhage induced by placement of the PA catheter during coronary artery bypass surgery. A contrast-enhanced CT scan of the chest confirmed spontaneous remission of the haemorrhage after 7 weeks of the injury without the need for any intervention.
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Affiliation(s)
- M Louai Shammaa
- Blackpool Victoria Hospital, Apartment 4, Tideswell House, 2 Tideswell Court, Sheffield, S5 6JH, UK
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11
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Reokklusion mit Thrombin nach Perforation der peripheren Pulmonalarterie mit Hämorrhagie während Rechtsherzkatheteruntersuchung. ACTA ACUST UNITED AC 2007. [DOI: 10.1007/s00390-007-0823-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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12
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Wang XR, Zheng YJ, Tian J, Wang ZH, Pan ZY. A preliminary study on the monitoring of mixed venous oxygen saturation through the left main bronchus. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2006; 10:R7. [PMID: 16356208 PMCID: PMC1550812 DOI: 10.1186/cc3914] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2005] [Revised: 10/15/2005] [Accepted: 10/24/2005] [Indexed: 11/17/2022]
Abstract
Introduction The study sought to assess the feasibility and accuracy of measuring mixed venous oxygen saturation (SvO2) through the left main bronchus (SpO2trachea) Methods Twenty hybrid pigs of each sex were studied. After anesthesia, a Robertshaw double-lumen tracheal tube with a single-use pediatric pulse oximeter attached to the left lateral surface was introduced toward the left main bronchus of the pig by means of a fibrobronchoscope. Measurements of SpO2trachea and oxygen saturation from pulmonary artery samples (SvO2blood) were performed with an intracuff pressure of 0 to 60 cmH2O. After equilibration, hemorrhagic shock was induced in these pigs by bleeding to a mean arterial blood pressure of 40 mmHg. With the intracuff pressure maintained at 60 cmH2O, SpO2trachea and SvO2blood were obtained respectively during the pre-shock period, immediately after the onset of shock, 15 and 30 minutes after shock, and 15, 30, and 60 minutes after resuscitation. Results SpO2trachea was the same as SvO2blood at an intracuff pressure of 10, 20, 40, and 60 cmH2O, but was reduced when the intracuff pressure was zero (p < 0.001 compared with SvO2blood) in hemodynamically stable states. Changes of SpO2trachea and SvO2blood corresponded with varieties of cardiac output during the hemorrhagic shock period. There was a significant correlation between the two methods at different time points. Conclusion Measurement of the left main bronchus SpO2 is feasible and provides similar readings to SvO2blood in hemodynamically stable or in low saturation states. Tracheal oximetry readings are not primarily derived from the tracheal mucosa. The technique merits further evaluation.
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Affiliation(s)
- Xiang-rui Wang
- Professor of anesthesiology, Department of Anesthesiology, Renji Hospital affiliated to Shanghai Second Medical University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Yong-jun Zheng
- Resident, Department of Anesthesiology, Renji Hospital affiliated to Shanghai Second Medical University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Jie Tian
- Resident, Department of Anesthesiology, Renji Hospital affiliated to Shanghai Second Medical University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Zheng-hong Wang
- Resident, Department of Anesthesiology, Renji Hospital affiliated to Shanghai Second Medical University, 1630 Dongfang Road, Shanghai, 200127, China
| | - Zhi-ying Pan
- Resident, Department of Anesthesiology, Renji Hospital affiliated to Shanghai Second Medical University, 1630 Dongfang Road, Shanghai, 200127, China
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13
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Stratmann G, Benumof JL. Endobronchial Hemorrhage Due to Pulmonary Circulation Tear: Separating the Lungs and the Air from the Blood. Anesth Analg 2004; 99:1276-1279. [PMID: 15502016 DOI: 10.1213/01.ane.0000140926.33753.4e] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Greg Stratmann
- *Department of Anesthesia, University of California San Francisco; and †Department of Anesthesia, University of California San Diego
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14
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Kaczmarek RG, Liu CHK, Gross TP. Medical Device Surveillance: Gender Differences in Pulmonary Artery Rupture after Pulmonary Artery Catheterization. J Womens Health (Larchmt) 2003; 12:931-5. [PMID: 14670173 DOI: 10.1089/154099903770948168] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Pulmonary artery (PA) rupture is a rare but often fatal complication of PA catheterization. METHODS An analysis was performed of all the case reports of PA rupture after PA catheterization that were submitted to the Food and Drug Administration's Medical Device Reporting (MDR) system between the years 1991 and 2001. The MDR system is a national passive surveillance system that includes adverse event reports from such sources as manufacturers and healthcare professionals. The Nationwide Inpatient Sample (NIS), a massive, nationally representative database maintained by the Agency for Healthcare Research and Quality, was examined to study patterns of PA catheter use. RESULTS A total of 71 PA rupture cases were identified from the MDR data. The most likely outcome following PA rupture was death. These PA ruptures were associated with 47 deaths and 24 injuries. The range of reported ages of the cases was between 40 and 91 years, with a mean age of 74 years. Of the 71 PA rupture cases, 52 were in women and 10 were in men, with gender not reported in 9 of the cases. There were significantly more cases in women than expected (Mantel-Haenszel common odds ratio estimate = 5.84, 95% confidence interval = 2.97 - 11.46, p < 0.001). CONCLUSIONS These data suggest that women may be at significantly greater risk of PA rupture after PA catheterization than men. Clinicians must be aware of the potential for this complication of PA catheterization.
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Affiliation(s)
- Ronald G Kaczmarek
- Center for Devices and Radiological Health, Food and Drug Administration, 1350 Piccard Drive, Rockville, MD 20850, USA.
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15
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Poplausky MR, Rozenblit G, Rundback JH, Crea G, Maddineni S, Leonardo R. Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm formation: three case reports and a review of the literature. Chest 2001; 120:2105-11. [PMID: 11742949 DOI: 10.1378/chest.120.6.2105] [Citation(s) in RCA: 80] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
The use of Swan-Ganz catheters has increased tremendously since they were first introduced in 1970. Their ability to give vital hemodynamic measurements in critically ill patients makes their use invaluable when providing quality medical care. The formation of pulmonary artery (PA) pseudoaneurysm from a Swan-Ganz catheter-induced perforation of the PA is a rare but potentially fatal complication of Swan-Ganz catheter use. Three case presentations and a review of the literature are presented.
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Affiliation(s)
- M R Poplausky
- Department of Radiology, New York Medical College, Westchester Medical Center, Valhalla, NY 10595, USA.
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16
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Karak P, Dimick R, Hamrick KM, Schwartzberg M, Saddekni S. Immediate transcatheter embolization of Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm. Chest 1997; 111:1450-2. [PMID: 9149612 DOI: 10.1378/chest.111.5.1450] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Digital subtraction angiography is an indispensable complement to cut film studies for the detection of pulmonary artery injury. Immediate transcatheter embolization of catheter-induced pulmonary artery pseudoaneurysm is a safe, minimally invasive, fast, and cost-effective alternative to surgical treatment.
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Affiliation(s)
- P Karak
- Department of Radiology, University of Alabama at Birmingham
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17
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Managing Pulmonary Artery Rupture. Am J Nurs 1996. [DOI: 10.1097/00000446-199611000-00025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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18
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Hassantash SA, Mock C, Maier RV. Traumatic visceral artery aneurysm: presentation as massive hemorrhage from perforation into an adjacent hollow viscus. THE JOURNAL OF TRAUMA 1995; 38:357-60. [PMID: 7897714 DOI: 10.1097/00005373-199503000-00008] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND While diagnosis of extremity pseudoaneurysm is usually straightforward, pseudoaneurysms arising from visceral arteries may be occult. Perforation of a visceral artery pseudoaneurysm into an adjacent hollow viscus with subsequent hemorrhage has been rarely reported. OBJECTIVE AND DESIGN To retrospectively evaluate the cause, clinical presentation, and outcome of patients with bleeding traumatic visceral artery aneurysms. MATERIALS AND METHODS Records of nine patients with visceral hemorrhage due to posttraumatic arterial aneurysms. RESULTS All had penetrating torso trauma 2 to 52 (mean, 12.3) weeks before presentation to our facility and had undergone 1 to 5 (mean, 2.2) prior operations. They had 2 to 15 episodes of hemorrhage into the gastrointestinal (seven cases), respiratory (one case), and urinary (one case) tracts. All underwent emergent surgery with ligation of the involved artery and resection of the corresponding portion of viscus. Evidence of prior attempts at hemostasis with multiple heavy ligatures was evident in all cases. All patients recovered without further complications. CONCLUSIONS Traumatic visceral artery aneurysms are usually due to penetrating trauma. They present as episodes of massive bleeding through one of the hollow viscera, and may stop bleeding without direct intervention only to occur again. Prompt operative therapy is usually necessary.
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Affiliation(s)
- S A Hassantash
- Department of Surgery, Shahid Beheshti University of Medical Sciences, Teheran, Iran
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19
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Jayaratnasingan S, Shah M, Kay P. Successful management of catheter induced pulmonary artery perforation by selective embolisation: Case report and review of current literature. J Cardiothorac Vasc Anesth 1994. [DOI: 10.1016/1053-0770(94)90401-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Benson J, Patla V. Real or apparent entrapment of a Swan-Ganz pulmonary artery catheter after cardiac surgery? Intensive Care Med 1994; 20:309-10. [PMID: 8046132 DOI: 10.1007/bf01708978] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
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21
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Shevde K, Raab R, Lee P. Decreasing the risk of pulmonary artery rupture with a pressure relief balloon. J Cardiothorac Vasc Anesth 1994; 8:30-4. [PMID: 8167282 DOI: 10.1016/1053-0770(94)90008-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
A pressure relief balloon has been recommended as one way to decrease catheter-related pulmonary artery rupture (PAR). There are approximately 1 to 2 PARs per 1,000 pulmonary artery catheter (PAC) insertions, resulting in significant morbidity and mortality. A new pressure relief balloon (PRB) introduced by Biosensors International (Singapore) was studied for its efficacy in increasing safety during PAC flotation balloon (FB) inflations. Ten human placentae were used for the experiment. The Biosensors PACs and the commonly used Baxter-Edwards (Irvine, CA) catheters were placed in placental veins and their FBs were gradually inflated with a maximum of 1.5 mL of air. Data revealed that PRBs consistently inflated when resistance was met by FBs and inflation pressure reached 1,000 mmHg. When PRBs were removed, the FBs inflated asymmetrically and distended beyond the catheter lumen or protruded through the vessel wall, causing bleeding upon deflation. Without the PRB, pressures reached up to 1,700 mmHg. In addition, the PRB gave visual evidence of resistance to the FB. In conclusion, the PRB is a safety device that limits overinflation of the distal PAC balloon, thus preventing vessel rupture. The device deserves serious consideration and outcome analysis.
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Affiliation(s)
- K Shevde
- Department of Anesthesia, Maimonides Medical Center, Brooklyn, NY 11219
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22
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DeLima LG, Wynands JE, Bourke ME, Walley VM. Catheter-induced pulmonary artery false aneurysm and rupture: case report and review. J Cardiothorac Vasc Anesth 1994; 8:70-5. [PMID: 8167290 DOI: 10.1016/1053-0770(94)90016-7] [Citation(s) in RCA: 43] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- L G DeLima
- Department of Anaethesia, University of Ottawa Heart Institute, Ottawa Civic Hospital, Ontario, Canada
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Abstract
Pulmonary artery rupture is an infrequent complication of flow-directed catheters. Because cardiopulmonary bypass offers an opportunity for control of gas exchange and hemorrhage, pulmonary artery rupture in this setting is different from that occurring in the intensive care unit and catheterization laboratory. A collective review of 30 published cases was conducted. Sixty-nine percent of patients were female and 50% had valvular heart disease. The right pulmonary artery was injured in 93% of cases. Arterial rupture presented with airway hemorrhage in 29 of 30 patients. Six patients presented with a herald airway bleed after catheter insertion but before operation. Three of 4 patients died when operation was performed in the face of a herald bleed. Airway hemorrhage most commonly developed during bypass weaning (19 cases). Recurrent hemorrhage occurred in 45% of patients (9/20) treated conservatively compared with 0% (0/7) in those having surgical control of bleeding (p = 0.07). Three patients died in the operating room. Overall mortality was 41%. Uncontrolled hemorrhage was the leading cause of death. Conservative management strategies are associated with a high incidence of secondary, often fatal, hemorrhage. Although pulmonary resection controls bleeding, mortality from other causes is a problem. A treatment protocol is proposed that considers these management dilemmas.
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Affiliation(s)
- J D Urschel
- Department of Surgery, University of Alberta, Edmonton, Canada
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