SCHNABEL, R

Van Zundert, Adrien

English

Ghent University Academic Bibliography

Intracardiac entrapment of a pulmonaryartery catheterdoi: 10.1111/j.1399-6576.2007.01321.xSir,We report a case of intracardial pulmonary artery catheter(PAC) anchoring by a surgical suture and subsequent trans-femoral Dotter retrieval snaring a 30-cm fragment of a brokenPAC during an attempt of forceful removal. A 40-year-oldCaucasian male patient (ASA II, height 195 cm, weight 101 kg)underwent an annuloplasty of the mitral valve after sudden heartfailure owing to ruptured chordae tendiniae resulting in severemitral valve regurgitation. A pre-operative PAC was inserteduneventfully at the start of the surgical intervention, via the rightinternal jugular vein, with a normal pulmonary artery tracingobtained at 42 cm. A mitral valve annuloplasty using a quadran-gular resection and a Carpentier-Edwards prosthetic 30-mm ringwas inserted. At the end of the operation, transoesophageal echo-cardiography confirmed a sufficient mitral valve. Post-operativelythe patient recovered well on the intensive care unit (ICU), wherehe was extubated 4 h later.The following day the patient was considered fit enough to betransferred to the ward and removal of the PAC was planned.Attempts to pull out and remove the PAC were not successful butit was felt that the catheter was loosening more and more. All ofa sudden, without using too much force, the catheter came out,although it became immediately obvious that the catheter wassheared-off with a split end, leaving some 30 cm inside the jugularvein (Fig. 1). It was decided to use non-surgical retrievement firstwith a cardiac surgeon on stand-by. The cardiologist introduceda sheath via the left femoral vein under direct fluoroscopy, whichshowed migration of the fragment to the right ventricle. AnAmplatz goose neck snare (ev3 Inc., Plymouth, MN) (1) was sitedover the broken PAC and the rest of the snared catheter wasretrieved easily. The patient recovered well without any furthercomplication and was discharged from the hospital after 6 days.Since its introduction several publications have reported com-plications associated with the use of PAC (2). A rare complication,however, can be a problematic catheter removal, which is notalways successful and may even result in a disaster, when theremoval procedure leads to tearing blood vessels with conse-quently massive blood loss and the need for resuscitation (3).Therefore no further pulling force should be exerted on thecatheter as soon as a resistance is felt at the time of removal.Instead visualization and radiological diagnosis of the problemshould be attempted first. A chest X-ray can give a first clue, whilefluoroscopy can be a valuable diagnostic tool (4, 5). It can revealan acute angle of the catheter suggesting fixation to the atrial wall.Furthermore, it is advised to use transoesophageal echocardiog-raphy to identify the exact location of catheter fixation (6, 7).Deformity of the atrial wall can be shown when traction on thePAC is applied. Fractured intravascular catheters tend to embo-lize if left in place and therefore the residual segment should beremoved as soon as possible.Surgeons and anaesthetists should be aware that PACs can beaccidentally fixed whenever a suture is placed in the vicinity ofcatheters, and that one should be vigilant when removing cathetersas they may become trapped along their intravascular track.R. SchnabelA. van ZundertReferences1. Saibil EA. Removal of a fractured retention wire of an Accufix‘J’ pacemaker lead with an Amplatz goose neck snare. J VascInterv Radiol 1996; 3: 367–9.2. Bossert T, Gummert JF, Bittner HB et al. Swan-Ganz-Catheter-induced severe complications in cardiac surgery: right ventric-ular perforation, knotting, and rupture of pulmonary artery. JCard Surg 2006; 21: 292–5.3. Huang HS, Wang HJ, Chen CH, Ho ST, Wong CS. Pulmonaryartery rupture after attempted removal of a pulmonary arterycatheter. Anesth Analg 2002; 95: 299–301.4. Pfeiffer K, Widmann M, Deutsch H, Guggenberger H, Duda S,Seboltdt H. Unbemerkte Nahtfixation eines Swan-Ganz-Kath-eters in der Arteria pulmonalis wa¨hrend Herzoperation. DerAnaesthesist 1995; 44: 782–4.5. Metha N, Lochab SS, Tempe DK, Trehan V, Nigam M. Success-ful nonsurgical removal of a knotted and entrapped pulmo-nary artery catheter. Cathet Cardiovasc Diagn 1998; 43: 87–9.Fig. 1. The pulmonary artery catheter (with split end removed bytraction) is shown, exactly split in the middle, with the other part(see the surgical suture rest) retrieved uneventfully by thecardiologist via the femoral vein.781Letters to the Editor6. Wang HJ, Wang SS, Liau CS. Transesophageal echocardio-graphic diagnoses of intracardiac entrapment of a Swan-Ganz-Catheter in open heart surgery. J Am Soc Echocardiogr 2004; 17:277–9.7. Rupert E, Paul A, Mukherji J. Transoesophageal echocardiog-raphy: a useful tool to diagnose entrapment of pulmonaryartery catheter. Anaesthesia 2006; 61: 702–4.Address:Andre´ van ZundertCatharina Hospital – Brabant Medical SchoolMichelangelolaan 2NL-5623 EJEindhovenThe Netherlands782Letters to the Editor

Intracardiac entrapment of a pulmonary artery catheter

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Intracardiac entrapment of a pulmonary artery catheter

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