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Swan-Ganz catheter entrapment in the heart, vena cava, or pulmonary artery is rare but may lead to life-threatening events. We report a case of severe tricuspid regurgitation resulting from papillary muscle rupture during percutaneous removal of a Swan-Ganz catheter (SCG) caught by a surgical suture. We performed urgent tricuspid valve repair by suturing the ruptured papillary muscle. This report highlights preventive measures to avoid suture-related entrapment and raises a word of caution regarding percutaneous removal of accidentally entrapped SCGs.

An 18-month-old boy had a Swan-Ganz catheter inserted through the right femoral vein. A chest roentgenogram after placement showed that the catheter was advanced too far and was curled with multiple loops in the right atrium. Under fluoroscopy, the catheter was pulled back into the inferior vena cava (IVC) where the multiple loops formed a knot that prevented passage beyond the IVC bifurcation (Fig A). A forceps catheter (BIOPAL 7 formable biopsy forceps; Cordis Corporation, Miami, FL) (arrows) was inserted through the contralateral femoral vein to unknot (Fig B) and remove (Fig C) the Swan-Ganz catheter. The procedure was uncomplicated, and the patient demonstrated no sequelae on follow-up. The array of tools available to the interventional radiologist including forceps, hook or straight catheter, loop snare, tip-deflecting wire, flexible-tip guidewire, and retrieval basket to facilitate in vivo reduction of catheter knots, often precluding the need for venotomy or surgical removal [1, 2]. We recommend slow withdrawal under fluoroscopy of any Swan-Ganz catheter that has multiple loops or appears knotted. If the catheter fails to unfurl or meets resistance, an interventional radiologist should be consulted while the loops are still accessible to instrumentation.

Swan-Ganz catheter-induced massive hemoptysis and later pulmonary artery false aneurysm occurred in a patient with prosthetic mitral regurgitation. This patient was successfully managed by double-lumen endotracheal intubation, control of pulmonary hypertension, reversal of anticoagulation, mitral valve re-replacement, and transcatheter embolization. The pertinent literature is reviewed.

Fifteen patients with rupture of the pulmonary artery by a Swan-Ganz catheter have been reported to date; 6 of them survived. The patient considered here underwent open-heart operation and then had severe bleeding secondary to distal pulmonary arterial rupture by a flow-directed balloon-tipped Swan-Ganz catheter. Knowledge of this specific complication may avoid needless delay in the diagnosis and control of postoperative bleeding.

A patient undergoing mitral and aortic valve replacement suffered catheter-induced pulmonary artery trauma and massive hemoptysis during weaning from cardiopulmonary bypass. Hemorrhage ceased when the ipsi-lateral pulmonary artery was occluded. Forty-eight hours later the temporary band was removed, and the patient did well without further bleeding.

Techniques of fixation, isolation, changes of position, and passing to the distal pulmonary artery of the Swan-Ganz catheter are described. They have been used in 210 patients requiring long-term hemodynamic monitoring at the Deborah Heart and Lung Center.