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A Swan‐Ganz catheter during cardiac surgery offers peri‐operative haemodynamic monitoring, although insertion of these catheters is not without risk. We report a case of Swan‐Ganz catheter entrapment within the tricuspid valve during elective off‐pump coronary artery bypass surgery. The diagnosis was made immediately by transoesophageal echocardiography, thus preventing forced withdrawal of the catheter. Intra‐operatively, the echocardiographically detected findings of complex entrapment was confirmed. The Swan‐Ganz catheter was tightly wrapped around the subvalvular apparatus, requiring on‐pump open surgical removal. This case illustrates the anatomical complexity of such a catheter entrapment around the tricuspid valve apparatus and the importance of rapid echocardiographic diagnosis to prevent iatrogenic damage.

Recruitment of the patent foramen ovale (PFO) while SCUBA diving has conventionally been thought to be caused by Valsalva maneuvers performed during ascent and may provide a route for venous air emboli to enter the arterial circulation. Alternatively, we hypothesized that mild increases in inspiratory and expiratory load, similar to that provided by a SCUBA regulator, would be sufficient to recruit the PFO. Two healthy adults with a PFO completed three randomized trials (inspiratory, expiratory, and combined (inspiratory/expiratory) loading) consisting of 6 levels of incrementally increasing load, to a maximum resistive load of 20 cmH2O/L/s. A saline contrast echocardiogram was performed at each resistive load to determine foramen ovale patency. Right atrial and pulmonary wedge pressures were obtained using a Swan Ganz catheter, and intrathoracic pressure was estimated using an esophageal balloon catheter. We found that PFO recruitment occurred in response to both inspiratory and expiratory loads. We will...

Swan-Ganz (S-G) catheters were introduced into pulmonary artery (PA) with the aid of multiplane transesophageal echocardiography (TEE) in 15 patients undergoing elective open heart surgeries. This method promptly allowed us to find the causes for the difficulties of the catheters in advancing through the tricuspid valve into the right ventricle and for the abnormalities in pressure waveform measured by the catheter. We could easily and safely place the S-G catheter in the PA by TEE guidance, indicating that TEE monitoring might be useful for placement of the S-G catheter in PA paticularly during operation and emergency situation.

We report on a case of temporary closure of a post-infarction ventricular septal defect (VSD) using a Swan-Ganz catheter through a femoral transvenous approach. This resulted in substantial improvement in the hemodynamic status of the patient. Six hr later, the patient underwent surgery for VSD closure. When immediate surgical intervention is not possible, it may be helpful to stabilize the patient until surgery can be performed. Thus, such a treatment has potential as a temporary measure for patients awaiting surgical repair of post-infarction VSD.

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.

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.

A patient is described in whom a multipurpose pulmonary artery catheter had been placed. Upon removal of the catheter, it was noted that the electrodes had become detached from the lead. A new method is described for insertion and removal of the catheter which will prevent this complication.