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Purpose of review In an attempt to make cardiovascular monitoring less invasive and more effective, transesophageal echocardiography is progressively being used in critically ill patients suffering from hemodynamic instability. This review analyses the capacity of transesophageal echocardiography to fully replace the pulmonary artery catheter in the management of hemodynamic impairment, as transesophageal echocardiography similarly allows for the measurement of central venous pressure, pulmonary arterial pressure, pulmonary capillary wedge pressure, pulmonary vascular resistance, stroke volume and cardiac output, and systemic vascular resistance. Recent findings Recently, the accuracy and clinical applicability of transthoracic echocardiography to establish the entire hemodynamic profile in patients with decompensated heart failure has convincingly been demonstrated. Because many principles are similar in transthoracic and transesophageal echocardiography, it has been hypothesized that the latter modality is also qualified to quantitatively determine intracardiac hemodynamics, including pressure and flow. Summary Transesophageal echocardiography has the potential to offer a noninvasive, valid alternative to Swan-Ganz catheters in the hemodynamic assessment of patients in the perioperative period.

Background— Although several studies have demonstrated a good correlation between Doppler echocardiographic and invasive measurements of single hemodynamic variables, the accuracy of echocardiography in providing a comprehensive assessment in individual patients has not been validated. The aim of this study was to assess the accuracy and clinical applicability of Doppler echocardiography in determining the entire hemodynamic profile in stable patients with advanced systolic heart failure. Methods and Results— Doppler echocardiography and Swan-Ganz catheterization were simultaneously performed in 43 consecutive patients with advanced heart failure. Echocardiographic data required for estimation of right atrial, pulmonary artery systolic, and pulmonary capillary wedge pressures; cardiac output; and pulmonary vascular resistance were obtained and compared with hemodynamic data. For all variables, invasive and noninvasive hemodynamic values were highly correlated ( P 3 Wood U) and pulmonary capillary wedge pressures (>20 mm Hg) at baseline, hemodynamic and Doppler measurements were simultaneously repeated after unloading manipulations. Absolute values and changes of pulmonary vascular resistance and pulmonary capillary wedge pressures after unloading were still accurately predicted ( r =0.96 and r =0.92, respectively). Conclusions— Doppler echocardiography may offer a valid alternative to invasive cardiac catheterization for the comprehensive hemodynamic assessment of patients with advanced heart failure, and it may assist in monitoring and optimization of therapy in potential heart transplant recipients.

The aim of this prospective study was to compare continuous cardiac output measurements of the non-invasive cardiac output system (NICO) with the pulmonary artery catheter during off-pump coronary bypass surgery.Twenty-two patients enrolled for off-pump coronary surgery received both a pulmonary artery catheter and a non-invasive cardiac output system for measurement of cardiac output. Data were compared by the Bland-Altman method to calculate the degree of agreement and to analyse if a significant difference existed between the two methods of cardiac output measurements.Perioperatively, the non-invasive cardiac output underestimated cardiac output, but postoperatively overestimated it. The limits of agreement were larger during surgery compared to the postoperative period (-3.1; +2.5 vs. -1.4; +2.2 L min(-1)). Perioperatively, cardiac output measured with the pulmonary artery catheter varied from 0.5 to 7.5 L min(-1) (mean 3.6 L min(-1)) and with the non-invasive cardiac output from 0.5 to 8.4 L min(-1) (mean 3.9 L min(-1)). Postoperatively, these were 2.5-7.7 L min(-1) (mean 4.5 L min(-1)) and 2.3-8.4 L min(-1) (mean 4.9 L min(-1)), respectively.During off-pump cardiac surgery, the non-invasive cardiac output reliably measures cardiac output and does it more rapidly than a pulmonary artery catheter and may be more useful in order to detect rapid haemodynamic changes.

Purpose of the review An adequate cardiac preload is essential in the treatment of critically ill patients. During anesthesia for thoracic surgery, volume and vasoactive therapy to optimize cardiac output, oxygen delivery (tissue perfusion) and to avoid pulmonary edema is a central therapeutic aspect. Cardiac preload has been estimated with different techniques in clinical practice, even though studies performed on thoracic anesthesia are lacking. Recent findings We analyze the conventional pulmonary artery catheter, transesophageal echocardiography and the transpulmonary indicator dilution technique as preload monitoring devices with their indications and limits in thoracic anesthesia. Summary The pulmonary artery catheter is confirmed as a fundamental device particularly in patients with pulmonary hypertension. For transesophageal echocardiography monitoring, the dependency on operator experience, the low repeatability and the high costs limit its interpretation and diffusion in clinical practice. During lung transplantation, Swan Ganz catheter monitoring is recommended. The optimization of fluid balance and vasoactive drug administration based on volumetric monitoring makes the transpulmonary indicator dilution technique a new option as an effective monitoring system during anesthesia for thoracic surgery when intravascular volume management is a primary objective.

Invasive hemodynamic monitoring has become standard in the management of aneurysmal subarachnoid hemorrhage. This study is a retrospective analysis of 630 Swan-Ganz catheters placed in 184 patients with aneurysmal subarachnoid hemorrhage. Evaluation of complications demonstrated a 13% incidence of catheter-related sepsis (81 of 630 catheters), a 2% incidence of congestive heart failure (13 of 630 catheters), a 1.3% incidence of subclavian vein thrombosis (8 of 630 catheters), a 1% incidence of pneumothorax (6 of 630 catheters), and a 0% incidence of pulmonary artery rupture. In the management of patients with aneurysmal subarachnoid hemorrhage, invasive hemodynamic monitoring continues to be an important tool with acceptable complications.

Pulmonary artery perforation is a rare but often fatal complication of right heart catheterization that is due to Swan-Ganz catheter (Edward Lifesciences, Irvine, Calif) placement.1–3 Treatment of a catheter-induced pulmonary artery rupture includes emergent intubation, lung resection, surgical pulmonary artery repair, and catheter-based pulmonary artery embolization.4,5 This case demonstrates a new therapeutic approach of injecting topical Thrombin-JMI (GenTrac Inc, Middleton, Wisc) through the distal port of the Swan-Ganz catheter to effectively treat a pulmonary artery rupture during a right heart catheterization. The patient was a 72-year-old woman with a past medical history of severe mitral valve regurgitation. Left heart catheterization was performed first with no complications. The coronary angiogram demonstrated minimal luminal irregularities in all 3 major coronary arteries. The left ventriculogram demonstrated +3 …

Massive hemoptysis secondary to pulmonary artery rupture is a rare but often fatal complication of pulmonary artery catheters (PACs). We report a case of delayed fatal hemoptysis secondary to rupture of a PAC-induced pseudoaneurysm, which was heralded by a small amount of hemoptysis in association with a normal postinsertion CXR

Les resultats sont importants pour comprendre la cause de la perforation de l'artere pulmonaire par le catheter. L'extremite distale migre plus loin au cours du degonflage chez les malades avec hypertension arterielle pulmonaire que chez les malades avec PAP normale

Swan-Ganz catheters have become a very valuable and frequently used method of monitoring hemodynamics in sick patients. Although the incidence of complications is very low, more reports are beginning to appear. One of the more serious complications is the rupture of the pulmonary artery. This report concerns three patients who had a rupture of the pulmonary artery who survived, including one of almost fatal exanguination. A literature review of all cases of pulmonary artery rupture is presented. Fifty-three per cent (8/15) were fatal. Emphasis is placed on the prevention of this by using the guidelines. Discussion also covers possible contributing causes and treatment. A high index of suspicion is necessary whenever a patient with the catheter has hemoptysis or unexplained cardiac or respiratory changes.

The intravascular volume and cardiac status of two patients who were thought to be at high risk to develop ischemic symptoms while undergoing graded cervical internal carotid artery occlusion were monitored by a dye dilution technique. Based on information obtained from this multivariable quantitative cardiopulmonary monitoring, measures were taken to maintain normo- to hypervolemia and to maximize cardiac performance. These medical adjuncts were thought to decrease the possibility of ischemic deficits while gradual occlusion of the internal carotid artery was being performed.

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.

An indwelling Swan-Ganz catheter was utilized for pulmonary angiography in an extremely ill patient without the necessity for a further invasive procedure. The procedure allowed prompt exclusion of pulmonary embolism as a cause of her deteriorating condition, and confirmed the diagnosis of adult respiratory distress syndrome (ARDS).

MgS04 was administered i.v. in 2 patients with eclampsia the first having also a pulmonary oedema. Hemodynamic studies with SWAN GANZ catheter and thermodilution technic were performed before and 30, 60 and 120 mn after the beginning of MgS04 administrztion. The decrease in blood pressure was associated with a decrease of the initially increased cardiac output but not with a decrease in systemic vascular resistance. The vasodilating effect of MgS04 was thus masked by the decrease in cardiac output. Since the wedge pressure did not increase, and the systolic pulmonary pressure decreased, whereas the cumulative water balance did not significantly decrease, the decrease in cardiac output seems to be due to an increase in venous compliance.