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(Circulation. 2009;119:e521-e522.)
© 2009 American Heart Association, Inc.

Images in Cardiovascular Medicine

Repair of a Perforated Pulmonary Artery Due to a Swan-Ganz Catheter Using Thrombin Injection

David R. Dobies, MD; Amanda L. Cohoon, RT, RCIS; Ashley A. Bates, BS

From the Genesys Heart Institute, Genesys Regional Medical Center, Grand Blanc, Mich (D.R.B., A.L.C.), and Michigan State University, East Lansing (A.A.B.).

Correspondence to David Dobies, MD, FACC, FSCAI, Director of Genesys Heart Institute, c/o Kimberly R. Barber, PhD, Office of Research, Suite 2442, Genesys Regional Medical Center, One Genesys Pkwy, Grand Blanc, MI 48439. E-mail kbarber@genesys.org

An extract of the first 250 words of the full text is provided, because this article has no abstract.

	Introduction

 
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.

	Case Presentation

 
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 mitral regurgitation with a 50% ejection fraction. Right heart catheterization was then performed using a 7.5Fr Swan-Ganz balloon-tipped catheter. The right atrial mean pressure was 8 mm Hg. Right ventricular pressure was 51/8 mm Hg. The pulmonary artery pressure was recorded at 51/20 mm Hg. The mean pulmonary capillary wedge pressure was 20 mm Hg.

On inflation of the balloon, the pulmonary artery perforated. This was made evident by frank hemoptysis shortly after balloon inflation. Intubation was selective to the right bronchus then pulled back to a position just above the carina. With the Swan-Ganz catheter remaining in the pulmonary artery, a "pulmonary wedge" angiogram via the distal port of the Swan-Ganz was performed using Isovue 370 (Bracco Diagnostics, Princeton, NJ). The angiogram demonstrated formation of . . . [Full Text of this Article]