Inadvertant atrial fixation of a Swan-Ganz catheter by suture and a method for its percutaneous removal

Pulmonary artery catheter entrapment in cardiac surgery

A pulmonary artery catheter (PAC) is an important tool in the preoperative cardiac management, and it provides measurements which helps in the patient management During open heart surgery the catheter tends to rest against the anterior lateral wall of the right atrium where the catheter may be caught by a suture in the cannulation for cardiopulmonary bypass. We describe a very rare complication which is inadvertent surgical suturing of the PAC to the inferior vena cava that necessitated reopening the chest, cutting, the suture and removing the catheter.

Inadvertent Entrapment of a Central Venous Catheter by a Purse-String Suture during Cardiopulmonary Bypass: A Case Report

A 65-year-old female patient with severe mitral valve stenosis plus coronary artery disease was scheduled for mitral valve replacement and 2-vessel coronary artery bypass graft (CABG) surgeries simultaneously. After a successful procedure, resistance was met on a CVC withdrawal. During postoperative fluoroscopy, fixation of the catheter at the heart was confirmed which necessitated reopening the chest, cutting the suture, and removing the catheter. When a catheter became hard to withdraw after open heart surgery, we should never withdraw it forcefully and blindly. Although rare, one should consider inadvertent entrapment of CVC by a suture as the possible cause.

Transesophageal echocardiographic diagnosis of intracardiac entrapment of a Swan-Ganz catheter in open heart operation

A Swan-Ganz catheter entrapment by a suture in the right atrial wall during open heart operation is presented. The diagnosis of the suture entrapment of the Swan-Ganz catheter to the right atrial wall was established by direct observation of the specific movement pattern of the cardiac structures when manual traction was applied from outside by a transesophageal echocardiographic examination.

Catheter entrapment by atrial suture during minimally invasive port-access cardiac surgery

PURPOSE

The port-access approach allows surgeons to perform heart operations through small intercostal openings, or "ports". This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retrograde cardioplegia) are positioned with the aid of fluoroscopy and transesophageal echography (TEE). Both catheters have a wider diameter than the more commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure.

CLINICAL FEATURES

A 35-yr-old man with severe mitral valve insufficiency was scheduled for valve repair. After a successful bypass procedure, resistance was felt while attempting to withdraw the PAV catheter. On fluoroscopy, fixation of the catheter at the heart level was established and perforation by suture was confirmed after injection of a contrast agent. Because of the risk of cardiac wall rupture and tamponade, the thorax was reopened. After release of some atrial sutures, the catheter could be withdrawn easily. Transfixion by a suture was confirmed by visual examination.

CONCLUSION

The more frequent use of a PAV catheter in minimally invasive cardiac surgery with the port-access technique should remind the anesthesiologist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during closure of the atriotomy via the port.

Ventricular entrapment of a Swan-Ganz catheter: a technique for nonsurgical removal

Entrapment of a balloon-tipped flow-directed catheter by atrial sutures during open heart surgery is a rare but serious complication. Several methods have been used to free such catheters with nonsurgical techniques. A case of entrapment in the right ventricle after repair of a ventricular septal defect is presented and a method for percutaneous removal described.