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A wide spectrum of complications is associated with invasive hemodynamic monitoring. We report an unusual case of perforation of the left internal mammary artery that occurred during percutaneous insertion of a Swan-Ganz catheter using the subclavian vein approach. To the best of our knowledge, this complication has not been previously reported. Cathet. Cardiovasc. Diagn. 44:317–319, 1998. © 1998 Wiley-Liss, Inc.

Knotting of a balloon-tipped, flow-directed catheter leading to difficulty in its removal is a rare but serious complication. Several methods have been used to remove such catheters with nonsurgical techniques. A case of knotted catheter that was also entrapped in a surgical suture in a patient undergoing emergency mitral valve replacement is presented and a method for its nonsurgical removal is described. Cathet. Cardiovasc. Diagn. 43:87–89, 1998. © 1998 Wiley-Liss, Inc.

Right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal-type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.

An 84-year-old patient with severe aortic valve stenosis suffered Swan-Ganz catheter-induced massive pulmonary hemorrhage. Immediate therapeutic embolism of the segmental artery by using a liquid, tissue-adhesive, occlusive agent (isobutyl-2-cyanoacrylate) controlled bleeding.

We report a case of perforation of the left brachiocephalic vein after insertion through the left internal jugular vein. Entrapment of air in the balloon occurred, possibly due to high surrounding tissue pressure at its base, preventing deflation. We emphasize the potential hazards of catheterization via the left internal jugular vein.

We describe a new stainless steel, teflon-coated 2.4 F pacemaker wire with a flexible tip that can be introduced through an extra lumen of a specially designed 7.5 F Swan-Ganz catheter. The extra lumen opens at 19 cm from the tip of the catheter; this opening can be positioned in the right ventricular cavity. The pacemaker wire can be introduced at the time of insertion of the Swan-Ganz catheter or later when the need for ventricular pacing arises. The Paceport catheter was tested in 23 patients. Satisfactory ventricular pacing was achieved in 19 patients at thresholds between 0.5 and 4.0 mA (median 2.0 mA). The threshold increased by 1 mA during long-term pacing (8-24 hr). Attempts to use the pacemaker were abandoned when short runs of ventricular tachycardia developed upon introduction, while an exceptionally high threshold was observed in another patient. The Paceport system is recommended for patients who require hemodynamic monitoring and urgent ventricular pacing.

Artifactual pulmonary wedge pressure measurements were encountered during bedside use of Swan-Ganz catheters. These values were higher than pulmonary artery end diastolic pressure and devoid of typical phasic contours. Utilizing fluoroscopy these artifacts were reproduced by advancing the catheter tip 2–4 cm beyond the site of initial wedging and reinflating the balloon. Spurious increases of pulmonary wedge pressure of up to 15 mm Hg were thus obtained. In vitro catheter testing demonstrated overlapping of the catheter tip by the deformed balloon when it was fully inflated in a channel too small to accomodate it. These measurement artifacts are thus attributed to distal migration of the catheter tip into relatively small pulmonary artery branches and to subsequent occlusion of the catheter lumen by the balloon when it is reinflated. This can readily be avoided by routinely inflating the balloon with the minimum volume of air sufficient to yield a pulmonary wedge pressure tracing.