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Dissecting aneurysm of the pulmonary artery is a rare (1 : 3000) but life threatening complication of the use of Swan-Ganz catheters. The most typical clinical manifestation is hemoptysis, even a asymptomatic aneurysm causes pathognomonic X-ray findings. The eventually long free intervall between catheterisation and formation of the dissecting aneurysm requires thorough follow up of the concerning patients, e. g. chest roentgenograms and thorax CT-scans. The endovascular therapy of this lesion has replaced surgery due to a much better risk profile. The aim of the endovascular treatment is a coil-occlusion of the parent artery immediately proximal to the aneurysm. The success of this procedure will be instantaneously evident.

Objective: Aim of the study was the evaluation of the impact of lung recruitment maneuvers on the hemodynamics following cardiac surgery procedures. Methods: The prospective randomized study included 80 adult patients undergoing coronary artery bypass surgery from 01/2009 till 09/2009. Patients were randomized to two duration's of lung recruitment maneuvers (25 cmH2O airway pressure for 10s and 45cm H2O for 10s) immediately after arriving on ICU. Swan Ganz catheter measurement was used to calculate cardiac output, and arterial blood pressure were monitored continuously. Systemic and pulmonary arterial blood gases were sampled before and after each lung recruitment maneuver to determine the intrapulmonary shunt. Results: Left ventricular end-diastolic areas decreased significantly during both the 10-s and the 20-s lung recruitment maneuvers. Cardiac output was 5.6±0.8l/min at baseline, decreasing by 3.0±1.1l/min and 3.6±1.2l/min during lung recruitment maneuvers of 10 and 20s, respectively. Shunt decreased from 20±5% to 15±6% after the first lung recruitment maneuver and from 15±6% to 12±5% after the second. Conclusions: Lung recruitment maneuvers markedly reduced cardiac output and left ventricular end-diastolic areas in hemodynamically stable patients following cardiac surgery.

We report on the successful transfemoral extraction of a Swan-Ganz catheter twice knotted in a patient's heart. The extraction was performed with a Dormia basket and removed via a 24F dilatator which was placed in the femoral vein. The Swan-Ganz catheter had been placed in a 67-year old patient after Whipple's operation. The technical procedure of the catheter removal is described and the advantages are discussed.

This case report describes the intraoperative fixation of a Swan-Ganz catheter at the left brachiocephalic vein by a suture during rethoracotomy in a cardiac surgical patient. In case of a rethoracotomy by median sternotomy the right-sided veins should be preferred for the insertion of a Swan-Ganz-catheter. Furthermore the free mobility of the catheter should be controlled before closure of the thorax.

Considering the wide use of Swan-Ganz catheter monitoring, remarkably little serious morbidity and mortality has been reported. It is my belief that continued formal training in this technique is the best way to minimize the complication rate. Since its use involves far more important skills than the ability to insert a catheter into the venous circulation, the physician must not only know the indications and limitations but must also be prepared to recognize and treat its potential complications. He must be familiar with the calibration of manometers and amplifiers and he must be competent in the interpretation of pressure curves and the determination of therapeutic consequences. However, in spite of the importance of continued formal training, PA catheterization should never become a routine technique. Inappropriate application and subsequent overuse of Swan-Ganz catheter monitoring must be avoided. It should be used only when precise hemodynamic data cannot be derived from non-invasive or clinical evaluation.