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Entrapment of a pulmonary artery catheter (Swan-Ganz catheter) in the heart, vena cava, or pulmonary artery is a very rare and serious complication that may lead to life-threatening complications such as cardiac rupture, pulmonary artery rupture, cardiac tamponade, among others, if not recognized and treated early. We report entrapment of a Swan-Ganz catheter in the purse-string suture at the inferior vena cava cannulation site for a patient undergoing aortic valve replacement. This situation required a repeat sternotomy to release the pulmonary artery catheter.

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.

The measurement of the cardiac output (CO) by thermodilution is based on an ancient method allowing its calculation, the principle of Fick (1829 – 1901) [1]. This author has described the possibility of calculating the CO by measuring the value of a marker, the O2, introduced into the arterial entry, via respiratory diffusion, and recovered at the venous exit, via respiratory exhalation, of the cardiovascular system. The method, indirect at the beginning and direct later, with the introduction of arterial and cardiac catheterization (the reason why A.F. Cournanad, D. W. Richardson, and W. T. Forsman received the Nobel prize in 1956), has allowed the determination of CO.

Pseudoaneurysm of the pulmonary artery (PA) induced by Swan-Ganz catheter injury is an important complication with high mortality. We report a case of PA pseudoaneurysm treated by PA repair. A 52-year-old woman developing infiltrate in the right lung field in chest radiography after a second mitral valve replacement was diagnosed with PA pseudoaneurysm confirmed by contrast-enhanced computed tomography and pulmonary angiography. The cause was considered Swan-Ganz catheter injury. The patient was carefully observed because there was no evidence of bronchial hemorrhage. The perforation was closed and the cavity plicated under extracorporeal circulation to avoid delayed rupture of the pseudoaneurysm when she underwent a third mitral valve replacement.

Dear Editor, The ProCESS study1 brings to mind the observation by Sir William Osler that (to paraphrase) one should use a new therapy as often as possible while it still works. I have used Swan Ganz catheters, aminophylline, bretyllium, MAST trousers, nasal intubation, ipecac and neonatal suction bulbs while they worked and abandoned them when they no longer …

A case is presented in which the insertion of a pulmonary artery catheter was complicated by the formation of a knot around the chordae tendineae of the tricuspid valve. The catheter was pulled out under fluoroscopic guidance using a guidewire inserted through the femoral vein.

Critically ill patients are worrisome for physicians. Threatening imminent death, they often defy complete understanding. In developed nations most such patients are managed in the intensive care unit (ICU) where they frequently receive a right heart catheter (RHC) (also known as a Swan Ganz catheter or a pulmonary artery catheter (PAC)). This is a monitoring device inserted into the heart. Developed in the 1940s, the RHC is now used in the ICU to monitor the function of the heart, providing information that allows the generation of data useful to assist in therapeutic efforts to improve the function of the heart. The “swan” as it has come to be referred to by those who use it, and the data it can be used to generate has become an integral part of caring for critically ill patients. While the RHC was initially only used in cardiac laboratories, it was adopted in the ICU after an article published in 1970 demonstrated an effective “bedside” technique for its insertion and use.

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.

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

We describe the case of a 52-year-old man with end-stage emphysema who underwent a right-sided lung transplantation. During preoperative monitoring an apparently non-functioning Swan-Ganz catheter could not be removed through the insertion site - right internal jugular vein. Another Swan-Ganz catheter was successfully installed through the left internal jugular vein, pulmonary artery pressures could be recorded and the transplant was performed uneventfully. Then, the first catheter was inspected and superior vena cava palpation surprisingly revealed a knot at approximately 25 cm. The catheter was pushed to the azygous vein, proximal and distal controls were obtained and a venotomy was performed. The knotted side was sectioned and removed, while the remaining catheter was removed through the insertion site. Despite being rare, knotted intravascular devices have been increasingly reported. Removal with interventional radiology techniques can be accomplished in most instances, nevertheless, complex knots or knots fixed into cardiac structures require open removal. Since in our case the knot was detected intraoperatively, it was readily removed through the azygous vein. To the best of our knowledge, this is the first report to describe such a route of removal.

Interpreting hemodynamic parameters requires both knowledge and practical experience. As emergency nurses care for more acutely ill patients during longer ED stays, an understanding of hemodynamic monitoring will be essential.

Over the past 24 months, a significant number ~of provocative editorials and articles have appeared either supporting the continued use of the Swan-Ganz catheter (Baxter Healthcare, Corp.) or declaring that a moratorium should be placed on its use.I-9 After reading these reports, we believe that too much has been asked of the pulmonary artery (PA) catheter. The historical development of the catheter demonstrates that it reached the bedside too quickly, without adequate laboratory or clinical research studies.lO-I 7 Furthermore, during those years, no practice guidelines for PA catheter use were agreed on; therefore, misconceptions associated with its use perpetuated. Compounding this was the growing body of evidence suggesting that catheter users lacked fundamental knowledge concerning PA catheter management and troubleshooting. 58 We believe, over the period of the PA catheter's lifetime, assessment of the catheter's capabilities were not fairly performed. Misconceptions were not considered as variables during the studies, nor was the impact of incomplete user knowledge regarding PA catheter insertion, management, and interpretation of data. The catheter's design and function--as well as its normal limitations, which may vary from patient to patient (ie, position of patient, position of catheter in thorax, ventilation

Does perioperative use of the intraaortic balloon pump (IABP) improve the postsurgical outcome of patients presenting with endstage coronary artery disease, unstable angina and low ejection fraction transferred for transmyocardial laser revascularization (TMLR)?TMLR, as sole therapy combined with the perioperative use of an intraaortic balloon pump has been assessed in seven patients with endstage coronary artery disease, unstable angina and low ejection fraction (EF35%). Six out of seven patients had signs of congestive heart failure. These patients are compared with 23 patients with endstage coronary artery disease, stable angina and EF35%, who were treated with TMLR as sole therapy without the use of IABP. The creation of transmural channels was performed by a CO2-laser. All patients were evaluated by hybrid positron emission tomography (perfusion SPECT and viability PET) and ventriculography preoperatively. Echocardiography, clinical status and hemodynamic assessment by Swan Ganz catheter were performed perioperatively.The perioperative mortality of this combined procedure (TMLR and IABP) was zero. Three out of seven patients had pneumonia with complete recovery. Swan Ganz catheter examinations showed deterioration of LV-function after TMLR intraoperatively and improvement after 2 h and further after 6 h on ICU (P0.05). In contrast, a decrease of LV-function in sole TMLR patients with an EF35%) has not been observed. Patients with EF35% needed the IABP for 2.3 days and moderate dose catecholamines for a mean of 3.0 days. The postoperative EF and resting wall motion score index (WMSI) of all analysed LV segments (evaluated by echocardiography) did not change compared to baseline (EF 31.3+/-2.6 preop. to 32.8+/-3.2 postop.; WMSI: 1.75+/-0.14 at baseline to 1.71+/-0.17 postop.). The average Canadian Angina Class at the time of discharge decreased from 4.0+/-0 (baseline) to 2.3+/-0.5 (P0.05) and the NYHA-Index from 3.9+/-0.3 to 2.7+/-0.5. No patient had signs of angina pectoris, whereas two patients still had signs of congestive heart failure.The reported data support our concept to start IABP preoperatively in patients with reduced LV contractile reserve in order to provide cardiac support during the postoperative phase of reversible decline of LV-function induced by TMLR.

Objective: We have shown that basic fibroblast growth factor (bFGF/FGF-2) enhances myocardial collateral development in a canine model of progressive coronary occlusion when delivered via the left atrial or intracoronary routes; however, we have found intravenous bFGF ineffective in the same model. Data on the fate and efficacy of intravenous bFGF are limited. We hypothesized that first pass lung uptake might limit myocardial bFGF availability after intravenous injection. We postulated that delivery of bFGF through the distal port of a wedged Swan Ganz catheter might circumvent this problem by restricting exposure of bFGF to a limited number of pulmonary binding sites. This study evaluated differential regional uptake of 125I labeled bFGF following bolus intravenous, Swan Ganz, left atrial, intracoronary, and pericardial delivery. Methods: Mongrel dogs were used. Human recombinant bFGF, monoiodinated with 125I, was mixed with cold bFGF to a specific activity of 0.03 μCi/μg. Approximately 100 μg/kg was injected per animal by the intravenous, left atrial, Swan Ganz, intracoronary, or pericardial route. Dogs were killed 15 min or 150 min later. The heart, lungs, liver, spleen, and kidneys were harvested and 125I activity was assessed. Immunohistochemical and pharmacokinetic studies were also performed. Results: Serum half life of bFGF was comparable after intracoronary, intravenous and left atrial delivery (50 min); however, there were significant differences with regard to pharmacodynamics. After intracoronary administration, 3–5% of the total bFGF dose was recovered from the heart, with the peptide immunolocalized to the extracellular matrix and vascular endothelium. In contrast, only 1.3% of the injected bFGF was localized to the heart after left atrial administration, and 0.5% was recovered after intravenous or Swan Ganz delivery. Pericardial administration resulted in substantial cardiac bFGF delivery; 19% was present at 150 min. Myocardial uptake was similar with Swan Ganz and intravenous delivery, suggesting that the administered dose did not saturate available pulmonary binding sites. Conclusions: These data predict efficacy of intracoronary, left atrial, and pericardial bFGF for myocardial angiogenesis, and a lack of efficacy after bolus intravenous and Swan Ganz administration.

Introduction: PIMR is a novel index of pulmonary microvascular function calculated from PressureWirederived distal pressure and flow. While PIMR has been reported in a large animal model of pulmonary arterial hypertension (PAH), its utility in the clinical setting has not been explored. Methods: Patients referred for diagnostic right heart catheterisation underwent Swan Ganz catheter and PressureWire (placed in 3rd order PA branch) measurement of pulmonary haemodynamics both before and during adenosine infusion. PIMR was calculated as mean transit time× (distal PA pressure−PA wedge pressure). Results: Thirty-eight subjects (average age 61 years) were studied including five normal, eleven PAH, fifteen heart failure with normal ejection fraction (HFNEF), five mitral valve disease, and two interstitial lung disease patients. Adenosine infusion resulted in 28% fall in pulmonary vascular resistance (PVR) and a 29% fall in systemic vascular resistance driven mainly by an increase in cardiac output (5.9± 0.3 L/min vs. 8.6± 0.4 L/min, p< 0.001). PIMR was closely related to PVR during adenosine (r= 0.63, p< 0.001). PIMR was higher in patients with transpulmonary gradient greater than 12 (6.9± 1.3 vs. 3.6± 0.9, p< 0.018) and in patients with PAH compared to those with HFNEF (10.5± 1.7 vs. 3.2± 0.4, p< 0.001). Conclusions: PIMR is closely related to PVR, suggesting that resistance in the pulmonary circulation occurs mainly at the microvascular level. While adenosine is an effective pulmonary vasodilator, its substantial effect on systemic resistance may make alternative agents such as PDE-5 inhibitors more attractive for pulmonary vasodilator challenge.

This study evaluates retrospectively the clinical presentation, radiographic findings, and angiographic management of false aneurysm of the pulmonary artery resulting from Swan-Ganz catheter placement.Over a 4-year period, seven false aneurysms of the pulmonary artery were diagnosed in five patients (four women, one man) who were 67-81 years old. All five patients underwent Swan-Ganz catheter placement to monitor cardiac surgery--coronary artery bypass grafting in four and mitral valve replacement in one. All patients were anticoagulated. For five patients, we reviewed the medical records and the results of chest radiography, digital subtraction pulmonary angiography, and pulmonary artery embolization. For two patients, we reviewed the results of CT scanning.Non-life-threatening hemoptysis was noted in all cases and occurred in three patients after the Swan-Ganz catheter had been removed (elapsed time of 1-19 days). Chest radiographs revealed a pulmonary infiltrate in one patient and a pulmonary mass in two patients. The results were unremarkable in the other two patients. CT depicted two false aneurysms of the pulmonary artery as round masses with eccentrically enhanced lumina circumscribed by thrombosis. Pulmonary angiography revealed a single false aneurysm in three patients and two false aneurysms in two patients. All false aneurysms were localized in segmental or subsegmental branches of the right middle pulmonary artery (n = 4) or the right lower pulmonary artery (n = 3). All patients were successfully treated with transcatheter steel-coil embolization.Even when the chest radiograph appears unremarkable, patients clinically suspected of developing a false aneurysm of the pulmonary artery after Swan-Ganz catheter placement require enhanced CT or pulmonary angiography to establish the diagnosis. False aneurysms of the pulmonary artery can be treated at the time of pulmonary angiography by steel-coil embolization.

An American study published earlier this month has shown that the use of a pulmonary artery catheter is associated with increased mortality in a wide range of conditions, including many of the accepted indications for using a catheter.1 Is this finding unexpected—and what should we do about it? Connors et al retrospectively reviewed 5735 critically ill patients with one of nine prespecified disease categories treated in 1989-94. They assessed the severity of illness in all patients and compared the outcome in those who received and those who did not receive a pulmonary artery catheter within the first 24 hours of care. The patients receiving a pulmonary artery catheter had higher APACHE III scores and lower predicted survival at two months. They also had higher mortality, length of stay, and financial costs. To compare with those who did not receive a pulmonary artery catheter, propensity scores (a new statistical method) were used to adjust for treatment selection. The results strongly suggest that in all groups mortality, the length of intensive care, and hospital costs were higher when a pulmonary catheter was used. Catheters seemed to have the highest associated risk in postoperative patients and those who were not severely ill. …

Arterial misplacement of the Swan-Ganz catheter occurs occasionally and usually can be easily detected. However, in some special clinical settings, the problem may become more complicated. We report a case of chronic obstructive pulmonary disease in which, because of severe hypoxemia, systemic hypotension, and pulmonary hypertension, conventional methods failed to recognize the misplacement, until confirmed with blood gas analysis.

The usefulness of a fiber optic Swan-Ganz catheter to monitor oxygen transport during volume expansion in a patient with ischemic neurologic deficits due to aneurysmal subarachnoid hemorrhage is illustrated. Usefulness of oxygen delivery and oxygen consumption measurements are presented. The role of oxygen transport in addition to cardiac hemodynamics and volume status in the management of these neurologic symptoms is emphasized.

We report the case of a 29-year-old man with decompensated alcoholic cardiomyopathy who developed a Staphylococcal pulmonic valve infective endocarditis during hemodynamic monitoring, as a consequence of catheter-related bacteremia. As experimentally demonstrated, the damaging role of the pulmonary artery catheter on the endocardial surface plays a major role in the pathogenesis of related right-sided infective endocarditis. Occurrence of bacteremia in a catheterized patient should be considered as a high risk situation, and righ-heart infective endocarditis must be suspected whenever patient presents fever or bacteremia without obvious site of infection. Doppler echocardiography is the reference diagnosis procedure.

Objectives To compared and evaluated the acute haemodynamic effects and safety of intravenous rhBNP versus nitroglycerin (NIT) in AMI patients with ADHF by Swan-Ganz catheter (6F, ARROW, Inc USA) monitoring through a prospectively designed study. Methods 42 consecutive AMI patients with ADHF were randomised into rhBNP group (n=21, 1.5 μg·kg −1 bolus intravenous injection followed by 0.0075 μg·kg −1 ·min −1 for the first 3 h and 0.015–0.03 μgċkg −1 ·min −1 infusion for following 21 h) and NIT group (n=21, 10 to 100 μg·min −1 intravenous infusion for 24 h). The invasive haemodynamic parameters were measured at the baseline, during 24 h of drug infusion and 6 h of post-infusion by Swan-Ganz catheter monitoring via subclavian access while total urine output during 30 h and relative serum chemistries were measured. MACE was followed up 1 week. Results As early as 30 min after the initiation of rhBNP, PCWP was reduced by 48.9% contrasted to baseline and cardiac index (CI) was increased by 27.1% at 1 h of rhBNP infusion respectively, (p 0.05), while serum potassium concentration in rhBNP group was significantly increased relative to baseline value (3.4±0.5 vs 4.0±0.4 mmol·L −1 , p Conclusions Intravenous injection of rhBNP results in more rapid, strong and prolong haemodynamic improvement than that of NIT in AMI patients with ADHF as well it is also feasible and safe in clinic as a selective agent for AMI patients with ADHF.

Elevated pulmonary vascular resistance (PVR) and pulmonary hypertension (PH) are high risk factors for early graft failure in orthotopic heart transplantation (oHTx). The need for an oversized donor in patients with elevated PVR aggravates the shortage of suitable donor organs. To decrease the elevated PVR to values suitable for orthotopic heart transplantation prostaglandin El (PGE1) was administered in 11 patients (11 male, mean age 49.2 years, mean dosage 35 ng/kg per min over 6–8 days). Ten days after the discontinuation of the PGE1 therapy, recatheterization was done. All haemodynamic data were determined by right heart catheterization using a Swan Ganz catheter and thermodilution technique before, and 10 days after, PGE1 treatment. The Wilcoxon signed ranks test was used for statistics. PVR significantly decreased in all patients (5.5 to 2.8 Wood units, P < 0.005). All patients were considered to be suitable for oHTX and put on the waiting list. At the time of writing, in eight of these patients (eight male, mean age 49.6 years; four ischemic, four dilatative CMP) oHTX had been successfully performed. No right ventricular failure occurred in the postoperative phase. These results sugest that long-term moderation of elevated PVR by PGE1 therapy weeks or months before transplantation enables oHTX in patients with elevated PVR.

A patient was referred to us with a tightly knotted Swan-Ganz catheter. The catheter could not be removed by conventional simple methods. We describe a minimally invasive means of removal of the catheter using an Amplatz gooseneck snare and an angioplasty balloon. This allowed the catheter to be removed without trauma.

Right heart catheterization with a Swan-Ganz balloon catheter via femoral vein in the patient with dilated right atrium and ventricle is frequently difficult due to excessive catheter coiling in the dilated atrium. A new technique is described in this situation. By using a modified transseptal-type sheath positioned counterclockwise in right atrium as an introducing sheath, a balloon catheter can be easily advanced to the distal pulmonary artery by smooth counterclockwise direction and secure support from this sheath.

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.

An 84-year-old patient with severe aortic valve stenosis suffered Swan-Ganz catheter-induced massive pulmonary hemorrhage. Immediate therapeutic embolism of the segmental artery by using a liquid, tissue-adhesive, occlusive agent (isobutyl-2-cyanoacrylate) controlled bleeding.

Background:Neuregulin-1 is a naturally occurring human protein, which is known to play a critical role in embryonic heart development, in maintaining normal cardiac function after birth and in the adaptation of the adult heart to injury. Neuregulin-1 inhibits apoptosis by activating ErbB2/ErbB4 receptors. We report the first study to demonstrate the effects of rhNRG-1, a 61-amino acid recombinant neuregulin-1 (beta2a isoform) receptoractivepeptide, inpatientswith stable chronic heart failure. Methods:Sixpatients on standard therapy forheart failure received rhNRG-1 as a continuous intravenous infusion over 6 h. A baseline right heart catheterisation was performed and Swan Ganz catheter left in situ to monitor haemodynamics for 24 h. Serial NT-proBNP measurements were also made. R a ( t 1 b 5 w p 1 C a u l

A Swan-Ganz catheter is a useful monitoring device for measuring the pulmonary artery pressure, pulmonary capillary wedge pressure and cardiac output, but its insertion brings about many complications, including dysrhythmias, pulmonary artery rupture, thrombosis and infection. We report here on a case of malposition of a Swan-Ganz catheter in a 49-year-old female patient who had undergone liver transplantation due to alcoholic liver cirrhosis.