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Sanfilippo F, Noto A, Ajello V, Martinez Lopez de Arroyabe B, Aloisio T, Bertini P, Mondino M, Silvetti S, Putaggio A, Continella C, Ranucci M, Sangalli F, Scolletta S, Paternoster G. The Use of Pulmonary Artery Catheters and Echocardiography in the Cardiac Surgery Setting: A Nationwide Italian Survey. J Cardiothorac Vasc Anesth 2024:S1053-0770(24)00302-1. [PMID: 38897888 DOI: 10.1053/j.jvca.2024.04.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Revised: 04/22/2024] [Accepted: 04/24/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Wide variations exist in the use of pulmonary artery catheters (PACs) and echocardiography in the field of cardiac surgery. DESIGN A national survey promoted by the Italian Association of Cardio-Thoracic Anesthesiologists and Intensive Care was conducted. SETTING The study occurred in Italian cardiac surgery centers (n = 71). PARTICIPANTS Anesthesiologists-intensivists were enrolled. INTERVENTIONS Anonymous questionnaires were used to investigate the use of PACs and echocardiography in the operating room (OR) and intensive care unit (ICU). MEASUREMENTS AND MAIN RESULTS A total of 257 respondents (32.2% response rate) from 59 centers (83.1% response rate) participated. Use of PACs seems less common in ORs (median insertion in 20% [5-70] of patients), with slightly higher use in ICUs; in about half of cases, it was the continuous cardiac output monitoring system of choice. Almost two-thirds of respondents recently inserted at least one PAC within a few hours of ICU admission, despite its need being largely preoperatively predictable. Protocols regulating PAC insertion were reported by 25.3% and 28% of respondents (OR and ICU, respectively). Transesophageal echocardiography (TEE) was performed intraoperatively in >75% of patients by 86.4% of respondents; only 23.7% stated that intraoperative TEE relied on anesthesiologists. Tissue Doppler and/or 3D imaging were widely available (87.4% and 82%, respectively), but only 37.8% and 24.3% of respondents self-declared skills in these modalities, respectively; 77.1% of respondents had no echocardiography certification, nor were pursuing certification (various reasons); 40.9% had not attended recent echocardiography courses. Lower PAC use was associated with university hospitals (OR: p = 0.014, ICU: p = 0.032) and with lower interventions/year (OR: p = 0.023). Higher independence in performing TEE was reported in university hospitals (OR: p < 0.001; ICU: p = 0.006), centers with higher interventions/year (OR: p = 0.019), and by respondents with less experience in cardiology (ICU: p = 0.046). CONCLUSION Variability in the use of PACs and echocardiography was found. Protocols regulating the use of PACs seem infrequent. University centers use PACs less and have greater skills in TEE. Training and certifications in echocardiography should be encouraged.
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Affiliation(s)
- Filippo Sanfilippo
- University Hospital Policlinico G. Rodolico-San Marco, Catania, Italy; Department of Surgery and Medical-Surgical Specialties, University of Catania, Catania, Italy.
| | - Alberto Noto
- Division of Anesthesia and Intensive Care, Department of Human Pathology of the Adult and Evolutive Age "Gaetano Barresi," Policlinico "G. Martino," University of Messina, Messina, Italy
| | - Valentina Ajello
- Department of Cardiac Anesthesia, Tor Vergata University Hospital, Rome, Italy
| | - Blanca Martinez Lopez de Arroyabe
- Cardiothoracic and Vascular Anesthesia and Intensive Care Unit, Department of Emergency and Intensive Care, University Hospital of Verona, Verona, Italy
| | - Tommaso Aloisio
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Pietro Bertini
- Department of Anesthesia and Critical Care Medicine, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Michele Mondino
- "De Gasperis" Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Simona Silvetti
- Department of Cardiac Anesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS-IRCCS Cardiovascular Network, Genova, Italy
| | - Antonio Putaggio
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | - Carlotta Continella
- School of Anesthesia and Intensive Care, University Magna Graecia, Catanzaro, Italy
| | - Marco Ranucci
- Department of Cardiothoracic and Vascular Anesthesia and Intensive Care Unit (ICU), Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Policlinico San Donato, Milan, Italy
| | - Fabio Sangalli
- Department of Anesthesia and Intensive Care, Azienda Socio-Sanitaria Territoriale Valtellina e Alto Lario, Sondrio, Italy
| | - Sabino Scolletta
- Department of Emergency-Urgency, University Hospital of Siena, Siena, Italy
| | - Gianluca Paternoster
- Department of Cardiovascular Anesthesia and ICU, San Carlo Hospital, Potenza, Italy
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Fontana F, Piacentino F, Curti M, Ierardi AM, Coppola A, Macchi E, De Marchi G, Faiella E, Santucci D, Moramarco LP, Del Grande F, Piffaretti G, Tozzi M, Imperatori A, Carcano G, Basile A, D'Angelo F, Carrafiello G, Venturini M. Pulmonary Artery Pseudoaneurysms Embolization: Bicentric Experience and Review of the Literature. J Clin Med 2023; 12:jcm12113796. [PMID: 37297991 DOI: 10.3390/jcm12113796] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 05/10/2023] [Accepted: 05/15/2023] [Indexed: 06/12/2023] Open
Abstract
The purpose of this bicentric case series was to report the safety, efficacy, and clinical outcome of transcatheter embolization in pulmonary artery pseudoaneurysms (PAPAs). Between January 2016 and June 2021, eight patients with PAPA were subjected to transcatheter embolization. The total number of patients was eight, of which five were female, with a mean age of 62 ± 14 years (average ± standard deviation). Etiology was traumatic in 2/8 cases and iatrogenic in 6/8 cases (after positioning a Swan-Ganz catheter in 5/6 cases and a temporary pacemaker in the latter case). In a single case, the PAPA was incidentally discovered during a routine X-ray, in the remaining 7 cases, the procedure was performed in emergency settings. PAPA embolization was performed using detachable coils alone in 3 cases; coils and glue in 1 case; coils, glue, and vascular plug in 1 case; coils and non-adhesive liquid embolic agents (Onyx and Squid respectively) in 2 cases; and non-adhesive liquid embolic agent alone (Onyx) in 1 case. No peri-procedural or post-procedural complications were recorded. Both the technical and clinical success rates were 100.0%. In conclusion, endovascular embolization is a technically feasible and safe therapeutic option for patients with PAPAs.
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Affiliation(s)
- Federico Fontana
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Filippo Piacentino
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
| | - Marco Curti
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Anna Maria Ierardi
- Radiology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20021 Milan, Italy
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
| | - Andrea Coppola
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Edoardo Macchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giuseppe De Marchi
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Eliodoro Faiella
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | - Domiziana Santucci
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
- Department of Radiology, Campus Bio-Medico University, 00128 Rome, Italy
| | | | - Filippo Del Grande
- Istituto di Imaging della Svizzera Italiana (IIMSI), Ente Ospedaliero Cantonale EOC, 6900 Lugano, Switzerland
| | - Gabriele Piffaretti
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Vascular Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Andrea Imperatori
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Thoracic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Giulio Carcano
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- General Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Antonio Basile
- Radiodiagnostic and Radiotherapy Unit, Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia", 95123 Catania, Italy
| | - Fabio D'Angelo
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
- Orthopedic Surgery Unit, ASST Settelaghi, 21100 Varese, Italy
| | - Gianpaolo Carrafiello
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Via Festa del Perdono, 7, 20122 Milan, Italy
- Radiology Unit, Sant'Anna Hospital, San Fermo della Battaglia, 22042 Como, Italy
| | - Massimo Venturini
- Diagnostic and Interventional Radiology Unit, ASST Settelaghi, 21100 Varese, Italy
- Department of Medicine and Surgery, Insubria University, 21100 Varese, Italy
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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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Giant pulmonary pseudoaneurysm following balloon dilatation of the pulmonary artery to relieve pulmonary band. Cardiol Young 2022; 33:832-834. [PMID: 36120917 DOI: 10.1017/s1047951122002980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Pulmonary artery pseudoaneurysms are uncommon. They may occur secondary to trauma, infectious diseases, vasculitis syndromes, neoplasms, congenital diseases, and pulmonary hypertension. Due to increasing number of cardiac interventions, iatrogenic complications are among the major causes of pulmonary artery pseudoaneurysms.In this report, we present a 6-month-old patient with pulmonary pseudoaneurysm that occurred following pulmonary balloon angioplasty for the relief of a pulmonary band.
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Leick J, Leinen S, Friedrich I, Werner N. Iatrogenic perforation of a pulmonary artery side branch-a case report. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab199. [PMID: 34151140 PMCID: PMC8209363 DOI: 10.1093/ehjcr/ytab199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 03/19/2021] [Accepted: 04/30/2021] [Indexed: 11/14/2022]
Abstract
Background The use of a pulmonary artery catheter (PAC) continues to be important for the diagnosis and therapeutic control of severe heart failure and in the diagnosis of pulmonary arterial hypertension. One of the most feared complications of this examination is perforation of a pulmonary artery with an estimated incidence of 0.031-0.05% and mortality rates of up to 70%. Case summary We report on an 80-year-old female patient who experienced a perforation of a pulmonary artery branch during the work-up of pulmonary arterial hypertension by PAC. Immediately after the perforation, haemodynamic shock developed rapidly, necessitating cardiopulmonary resuscitation. Occlusion of the pulmonary artery branch with a semicompliant balloon was applied immediately. After 40 min of occlusion, the bleeding persisted, and endovascular coil implantation was performed. Subsequently, the bleeding stopped, and the haemodynamics stabilized. After treatment, the patient was discharged home without any significant sequelae. Discussion Treatment options in pulmonary artery perforation are limited, especially if the patient is inoperable and if balloon occlusion fails. Based on our results, endovascular coil embolization can be considered a therapeutic option.
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Affiliation(s)
- Juergen Leick
- Heart Centre Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany
| | - Stefan Leinen
- Heart Centre Trier, Department of Internal Intensive Care Medicine, Barmherzige Brueder, Hospital, Nordallee 1, 54296 Trier, Germany
| | - Ivar Friedrich
- Heart Centre Trier, Department of Cardiac and Thoracic Surgery, Barmherzige Brueder, Hospital, Nordallee 1, 54296 Trier, Germany
| | - Nikos Werner
- Heart Centre Trier, Department of Cardiology, Barmherzige Brueder Hospital, Nordallee 1, 54296 Trier, Germany
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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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Al Sergani R, Galzerano D, Parato VM, Al Admawi M, AlJufan M. Giant Iatrogenic Pseudoaneurysm of Right Pulmonary Artery Compressing the Left Atrium. JACC Case Rep 2020; 2:870-872. [PMID: 34317370 PMCID: PMC8302032 DOI: 10.1016/j.jaccas.2020.03.035] [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: 10/24/2019] [Revised: 02/14/2020] [Accepted: 03/03/2020] [Indexed: 10/25/2022]
Abstract
We describe a case of giant pseudoaneurysm of the right pulmonary artery compressing the left atrium after percutaneous pulmonary valve implantation and right pulmonary artery dilatation. Such a complication mimicking an intracavity left atrial mass and treated successfully by stent placement has never, to the best of our knowledge, been reported. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Reem Al Sergani
- College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Domenico Galzerano
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Vito Maurizio Parato
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia.,Emergency Department, Cardiology Unit, Azienda Sanitaria Unica Regionale ASUR, Marche, Health Public Company of Marche Region, San Benedetto del Tronto, Italy
| | - Mohammed Al Admawi
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mansour AlJufan
- The Heart Centre, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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9
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Brief review: Pulmonary artery aneurysms and pseudoaneurysms. Int J Cardiovasc Imaging 2019; 35:1357-1364. [DOI: 10.1007/s10554-019-01547-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2018] [Accepted: 01/24/2019] [Indexed: 11/27/2022]
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10
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Goldhammer JE, Herman CR. Delining Without Deinforming. J Cardiothorac Vasc Anesth 2018; 32:2503-2504. [DOI: 10.1053/j.jvca.2018.05.049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2018] [Indexed: 11/11/2022]
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Marcelin C, Soussan J, Desmots F, Gaubert JY, Vidal V, Bartoli JM, Izaaryene J. Outcomes of Pulmonary Artery Embolization and Stent Graft Placement for the Treatment of Hemoptysis Caused by Lung Tumors. J Vasc Interv Radiol 2018; 29:975-980. [DOI: 10.1016/j.jvir.2018.01.773] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 01/12/2018] [Accepted: 01/13/2018] [Indexed: 11/28/2022] Open
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Valente T, Abu-Omar A, Sica G, Clemente A, Muto M, Bocchini G, Cappabianca S, Rea G. Acquired peripheral pulmonary artery aneurysms: morphological spectrum of disease and multidetector computed tomography angiography findings-cases series and literature review. Radiol Med 2018; 123:664-675. [PMID: 29721920 DOI: 10.1007/s11547-018-0900-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 04/20/2018] [Indexed: 01/15/2023]
Abstract
BACKGROUND Acquired peripheral or intraparenchymal pulmonary artery aneurysms (PPAA) are rare entities but are important to recognize because of the associated morbidity. Hemoptysis is their principal complication and is a potentially fatal condition. PURPOSE To illustrate the causes, multidetector CT angiography (MDCTA) findings and differential diagnosis of acquired PPAA. MATERIALS AND METHODS The institutional review boards approved this study. We conducted a retrospective review of the demographic data and the results of clinical and laboratory examinations, and imaging studies of patients managed between January 2012 and January 2017 in two institutions. RESULTS A total of 19 patients had acquired PPAA that were detected at MDCTA, 9 patients with normal pulmonary artery pressures and 10 with pulmonary hypertension. Nine patients developed PPAA-related acute symptoms. MDCTA features of PPAA include: a lobulated vascular mass, an indistinct irregular arterial wall, aneurysmal thrombosis or wall calcification, findings of impending rupture including perianeurysmal edema, gas or a soft tissue mass. CONCLUSION PPAA are rare. In our series, endocarditis and pulmonary hypertension are the PPAA leading causes. The treatment modality preferred is embolization, especially as surgery poses a very high risk for patients with severe pulmonary hypertension. Further clarification of the natural history of these rare arterial aneurysms is needed.
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Affiliation(s)
- Tullio Valente
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy.
| | - Ahmad Abu-Omar
- Department of Radiology, The James Cook University Hospital NHS Trust, Marton Road, Middlesbrough, TS4 3BW, UK
| | - Giacomo Sica
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Alfredo Clemente
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Massimo Muto
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Giorgio Bocchini
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
| | - Salvatore Cappabianca
- Department of Radiology and Radiotherapy, University of Campania "Luigi Vanvitelli", Piazza Miraglia, 80138, Naples, Italy
| | - Gaetano Rea
- Department of Diagnostic Imaging, Section of General Radiology, Azienda Ospedali dei Colli, P.O. Monaldi, Via Leonardo Bianchi, 80131, Naples, Italy
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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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14
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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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15
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Schorer R, Badoual A, Bastide B, Vandebrouck A, Licker M, Sage D. A feasability study of color flow doppler vectorization for automated blood flow monitoring. J Clin Monit Comput 2016; 31:1167-1175. [PMID: 27838880 DOI: 10.1007/s10877-016-9953-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 11/04/2016] [Indexed: 11/30/2022]
Abstract
An ongoing issue in vascular medicine is the measure of the blood flow. Catheterization remains the gold standard measurement method, although non-invasive techniques are an area of intense research. We hereby present a computational method for real-time measurement of the blood flow from color flow Doppler data, with a focus on simplicity and monitoring instead of diagnostics. We then analyze the performance of a proof-of-principle software implementation. We imagined a geometrical model geared towards blood flow computation from a color flow Doppler signal, and we developed a software implementation requiring only a standard diagnostic ultrasound device. Detection performance was evaluated by computing flow and its determinants (flow speed, vessel area, and ultrasound beam angle of incidence) on purposely designed synthetic and phantom-based arterial flow simulations. Flow was appropriately detected in all cases. Errors on synthetic images ranged from nonexistent to substantial depending on experimental conditions. Mean errors on measurements from our phantom flow simulation ranged from 1.2 to 40.2% for angle estimation, and from 3.2 to 25.3% for real-time flow estimation. This study is a proof of concept showing that accurate measurement can be done from automated color flow Doppler signal extraction, providing the industry the opportunity for further optimization using raw ultrasound data.
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Affiliation(s)
- R Schorer
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospital, 1205, Geneva, Switzerland.
| | - A Badoual
- Biomedical Imaging Group, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - B Bastide
- Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - A Vandebrouck
- Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
| | - M Licker
- Department of Anaesthesiology, Pharmacology and Intensive Care, Geneva University Hospital, 1205, Geneva, Switzerland
| | - D Sage
- Biomedical Imaging Group, Ecole Polytechnique Fédérale de Lausanne (EPFL), 1015, Lausanne, Switzerland
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16
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Naumann DN, Midwinter MJ, Hutchings S. Venous-to-arterial CO2 differences and the quest for bedside point-of-care monitoring to assess the microcirculation during shock. ANNALS OF TRANSLATIONAL MEDICINE 2016; 4:37. [PMID: 26889490 DOI: 10.3978/j.issn.2305-5839.2015.12.61] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The microcirculation is the anatomical location of perfusion and substrate exchange, and its functional impairment is of paramount importance during the state of shock. The difference in venous-to-arterial carbon dioxide partial pressures (Pv-aCO2) has recently been reported to correlate with microcirculatory dysfunction during early septic shock with greater fidelity than global hemodynamic parameters. This makes it a potential candidate as a point-of-care test in goal directed therapy that aims to restore microcirculatory function in an emergency clinical context. This early work needs to be explored further, and a better understanding of Pv-aCO2 during the resuscitation and subsequent patient progression is required. The quest for an ideal bedside point-of-care test for microcirculatory behavior is ongoing, and is likely to consist of a combination of non-invasive sublingual microcirculatory monitoring and biochemical tests that reflect tissue perfusion. These tools have the potential to provide more accurate and clinically relevant data with regards to the microcirculation that more conventional resuscitative monitoring such as blood pressure, cardiac output, and serum lactate.
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Affiliation(s)
- David N Naumann
- 1 NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, B152TH, UK ; 2 Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Mark J Midwinter
- 1 NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, B152TH, UK ; 2 Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
| | - Sam Hutchings
- 1 NIHR Surgical Reconstruction and Microbiology Research Centre, Queen Elizabeth Hospital, Birmingham, B152TH, UK ; 2 Kings College Hospital, Denmark Hill, London, SE5 9RS, UK
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17
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Cordovilla R, Bollo de Miguel E, Nuñez Ares A, Cosano Povedano FJ, Herráez Ortega I, Jiménez Merchán R. Diagnosis and Treatment of Hemoptysis. Arch Bronconeumol 2016; 52:368-77. [PMID: 26873518 DOI: 10.1016/j.arbres.2015.12.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Revised: 11/11/2015] [Accepted: 12/07/2015] [Indexed: 12/20/2022]
Abstract
Hemoptysis is the expectoration of blood from the tracheobronchial tree. It is commonly caused by bronchiectasis, chronic bronchitis, and lung cancer. The expectorated blood usually originates from the bronchial arteries. When hemoptysis is suspected, it must be confirmed and classified according to severity, and the origin and cause of the bleeding determined. Lateral and AP chest X-ray is the first study, although a normal chest X-ray does not rule out the possibility of malignancy or other underlying pathology. Multidetector computed tomography (MDCT) must be performed in all patients with frank hemoptysis, hemoptoic sputum, suspicion of bronchiectasis or risk factors for lung cancer, and in those with signs of pathology on chest X-ray. MDCT angiography has replaced arteriography in identifying the arteries that are the source of bleeding. MDCT angiography is a non-invasive imaging technique that can pinpoint the presence, origin, number and course of the systemic thoracic (bronchial and non-bronchial) and pulmonary arterial sources of bleeding. Endovascular embolization is the safest and most effective method of managing bleeding in massive or recurrent hemoptysis. Embolization is indicated in all patients with life-threatening or recurrent hemoptysis in whom MDCT angiography shows artery disease. Flexible bronchoscopy plays a pivotal role in the diagnosis of hemoptysis in patients with hemoptoic sputum or frank hemoptysis. The procedure can be performed rapidly at the bedside (intensive care unit); it can be used for immediate control of bleeding, and is also effective in locating the source of the hemorrhage. Flexible bronchoscopy is the first-line procedure of choice in hemodynamically unstable patients with life-threatening hemoptysis, in whom control of bleeding is of vital importance. In these cases, surgery is associated with an extremely high mortality rate, and is currently only indicated when bleeding is secondary to surgery and its source can be accurately and reliably located.
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Affiliation(s)
- Rosa Cordovilla
- Servicio de Neumología, Complejo Asistencial Universitario de Salamanca, Salamanca, España.
| | | | - Ana Nuñez Ares
- Servicio de Neumología, Complejo Hospitalario Universitario de Albacete, Albacete, España
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18
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Ierardi AM, Xhepa G, Musazzi AM, De Chiara M, Beghi C, Carrafiello G. Endovascular treatment of a pulmonary artery pseudoaneurysm caused by Swan-Ganz catheter deployment in an anticoagulated patient. BJR Case Rep 2015; 1:20150064. [PMID: 30363577 PMCID: PMC6180823 DOI: 10.1259/bjrcr.20150064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Revised: 06/21/2015] [Accepted: 07/06/2015] [Indexed: 11/05/2022] Open
Abstract
We present a case report of an anticoagulated 78-year old man presenting a pulmonary artery pseudoaneurysm following Swan-Ganz catheter deployment after an aortic valve and aortic root replacement. Diagnosis was established by cone beam CT angiography and catheter angiographyand embolisation was achieved via a combination of plug and glue. This case emphasises the importance of endovascular techniques in the management of iatrogenic pulmonary pseudoaneurysms and shows the benefit of using highly hemostatic polymeric agent in anticoagulated patients to obtain a rapid and effective occlusion.
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Affiliation(s)
- A M Ierardi
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - G Xhepa
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - A M Musazzi
- Cardiac Surgery Department, Department of Radiology, Insubria University, Varese, Italy
| | - M De Chiara
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
| | - C Beghi
- Cardiac Surgery Department, Department of Radiology, Insubria University, Varese, Italy
| | - G Carrafiello
- Interventional Radiology, Department of Radiology, Insubria University, Varese, Italy
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Gu YY, Wang LY, Chen LX. Double-tube negative pressure drainage for reducing intra-abdominal infection in patients after gastrointestinal operation: Efficacy and nursing intervention. Shijie Huaren Xiaohua Zazhi 2014; 22:4510-4513. [DOI: 10.11569/wcjd.v22.i29.4510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To assess the effect of double-tube negative pressure drainage in the prevention of intra-abdominal infections in patients after gastrointestinal operation and to investigate appropriate nursing intervention.
METHODS: Eighty patients with intra-abdominal infections after gastrointestinal operation treated at our hospital from May 2012 to May 2013 were enrolled and randomly divided into two groups (40 cases in each one) to receive double-tube negative pressure drainage (study group) and traditional latex drainage (control group), respectively. The number of cases of abdominal infection, the infective microorganisms, and the time to removal of drainage tube were analyzed and compared between the two groups.
RESULTS: The infection rate was significantly lower in the study group (10%) than in control group (37.5%) (P < 0.05). The number of cases infected with Staphylococcus aureus was significantly less in the study group than in the control group (P < 0.05). The numbers of cases infected with Acinetobacter baumannii and fungi were less in the study group than in the control group, but the differences were not significant (P > 0.05). The time to removal of drainage tube was significantly shorter in the study group (10 d ± 1.5 d) than in the control group (12 d ± 2.3 d) (P < 0.05).
CONCLUSION: Double-tube negative pressure drainage after gastrointestinal operation can reduce postoperative infections, especially Staphylococcus aureus infection, and shorten the time to recovery.
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