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The use of the Swan-Ganz flow-directed right heart catheter should be a considerable aid in obtaining diagnostic information in complex congenital heart disease. It is safe and requires little technical expertise. Its use should decrease considerably the amount of radiation exposure to both patient and operator.

Pressures in the right side of the heart and pulmonary capillary wedge can be obtained by cardiac catheterization without the aid of fluoroscopy. A No. 5 Fr double-lumen catheter with a balloon just proximal to the tip is inserted into the right atrium under pressure monitoring. The balloon is then inflated with 0.8 ml of air. The balloon is carried by blood flow through the right side of the heart into the smaller radicles of the pulmonary artery. In this position when the balloon is inflated wedge pressure is obtained. The average time for passage of the catheter from the right atrium to the pulmonary artery was 35 seconds in the first 100 passages. The frequency of premature beats was minimal, and no other arrhythmias occurred.

The Swan-Ganz balloon catheter was used during cardiac catheterization of 40 infants and children. The flow directional properties of the catheter proved useful in manipulating it into the great arteries of the patients with complex cardiac anomalies and in passing it from the left atrium and ventricle into the aorta in order to avoid an arteriotomy. Manipulation was considerably more difficult than has been described in adults. Failure to enter the desired great artery and difficulty in manipulation were more frequent in the smaller patients and in those with subpulmonic stenosis. The catheter was also useful in obtaining pulmonary arterial wedge pressures and angiograms. Complications were minor and limited to two burst balloons and temporary occlusion of a narrowed pulmonic outflow. There were no major arrhythmias, and ventricular ectopic beats were uncommon.

Forty patients were studied by the Swan–Ganz flow directed catheter and the wedge pressure was shown to be identical with that obtained by a Cournand and correlated well with the direct left atrial pressure. It is confirmed that the technique is both simple and rapid.

A patient with severe respiratory failure due to overwhelming pneumonia was monitored with a Swan-Ganz catheter. Postmortem examination revealed massive antemortem thrombosis surrounding the Swan-Ganz catheter tip. The presence of the thrombus about the catheter tip was not suspected before death, but retrospective analysis of a variety of parameters suggested massive pulmonary vascular obstruction.

Migration of a polyethylene catheter to the pulmonary artery has occurred on three occasions within a period of 9 months. Nonsurgical removal was accomplished in all cases with a snare dev...

Complete heart block was caused by passage of a Swan-Ganz catheter into the pulmonary artery of a patient with acute myocardial infarction and complete left bundle branch block. This complication could be easily treated with the prophylactic insertion of a temporary pacing catheter.