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Two cases of histologically documented tricuspid valve ulcers caused by use of Swan-Ganz catheters are described. The implication of these clinically silent erosions is discussed.

A method is described for simple, rapid Swan-Ganz catheter insertion. In addition, a new technique for replacement of Swan-Ganz catheters without the need for additional venipuncture is presented.

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.

To the Editor .—The Swan-Ganz catheter has become an important tool for monitoring critically ill surgical patients in the intensive care unit. 1 Like all invasive diagnostic or therapeutic modalities, the Swan-Ganz catheter is associated with infrequent, but real, risks. Cardiac arrhythmias, perforation of the pulmonary artery, pulmonary infarction, and catheterassociated bacteremia are among such complications. The passage of the catheter in critically ill patients, even those with intrinsic cardiac disease, is reputed to be safe, although transient rhythm disturbances may be identified in as many as 30% of the patients at the time of placement. 2 Reports of fatal or near-fatal cardiac arrhythmias are rare. Thus, there are essentially no contraindications to Swan-Ganz catheter placement. Our recent experience suggests that a patient with hyperkalemia and metabolic acidosis may not warrant immediate catheter placement. Report of a Case .—A 73-year-old man underwent a coronary artery bypass for symptomatic ischemic heart

Excerpt To the editor: In a recent perspective, Robin (1) criticizes the overuse and abuse of pulmonary arterial catheters. We share his concern about the indiscriminant use, the many risks, and th...

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.

Excerpt To the editor: There is a strong possibility that the use of pulmonary artery flow (Swan-Ganz) catheters in patients with acute myocardial infarction is associated with a high rate of exces...

To the Editor.— Since its introduction in 1970, the Swan-Ganz catheter has proved extremely useful in the hemodynamic evaluation of cases of shock and myocardial infarction.1Under most circumstances, it can be passed at the bedside (under hemodynamic monitoring alone) with ease. However, some complications of catheter passage have been documented, including ventricular fibrillation,2intracardiac knotting,3,4and atrial arrhythmias.5We describe a previously unreported complication— entanglement of a Swan-Ganz catheter around a papillary muscle to the right ventricle. Report of a Case.— A 57-year-old man had a history of hypertension and a cerebrovascular accident eight years prior to admission. On the day of admission he complained of crushing substernal chest pain. His initial ECG showed an acute posterior- and lateral-wall myocardial infarction. He was admitted to the coronary care unit and had an uneventful initial course except for a period of transient atrial fibrillation. Serial enzyme

To the Editor.— The article by Van Deventer et al, "The Superior Vena Cava Syndrome: A Complication of the LeVeen Shunt" (242:1655, 1979), brings to mind another interesting point in reference to etiology. We recently performed an autopsy on a patient with similar pathological findings, involving the superior vena cava, right innominate vein, right subclavian vein, and right internal jugular vein that were related to insertion of a Swan-Ganz catheter. Report of a Case.— A 34-year-old man had an acute myocardial infarction in May 1979. Clinicians had difficulty inserting a Swan-Ganz catheter for a temporary pacemaker. They finally succeeded via the right internal jugular vein. The patient's illness was complicated by a postinfarction ventricular aneurysm and heart failure. Cardiac catheterization was done in July and August, which showed a nondominant, trivial right coronary artery, patent left circumflex artery, 70% occlusion of the left anterior descending artery, calcified aortic stenosis, and

The use of pulmonary artery flow-directed catheters has assumed epidemic proportions without clinical trials establishing improved outcome as a result of their use. During the past 10 years, however, it has become clear that improved outcome is found only in small groups of patients and that use of these catheters is associated with considerable risks of morbidity and mortality. A clinical trial is urgently needed to assess the balance between risks and benefits. While awaiting such trials, physicians should limit catheter use to circumstances in which there is a large probability that the data will result in more effective management; the measurements should only be used to answer specific questions about patient therapy. This situation will occur in a relatively small number of patients.