Ann Thorac Surg 2003;75:639
© 2003 The Society of Thoracic Surgeons
Correspondence
Successful interventional treatment of a large pulmonary artery aneurysm after Swan-Ganz catheterization
Harald Brandes, MD,
Johannes M. Albes, MD
Cardiac, Thoracic, and Vascular Surgery, University Hospital Jena, Bachstraße 18, 07743 Jena, Germany
To the Editor:
We have read with great interest the article by Sirivella and associates, who experienced Swan-Ganz catheter–induced pulmonary artery trauma in 12 cases over a 15-year period in their clinical experience with cardiac procedures [1]. They mentioned a single but frustrating attempt to control aneurysmal enlargement and subsequent rupture by means of catheter embolization.
Recently, we successfully performed such a catheter embolization. An 86-year-old female patient underwent aortic valve replacement and developed ventricular fibrillation in the operating theater. Closed chest massage was performed while a Swan-Ganz catheter was in place. After an initially stable period in the intensive care unit, a false aneurysm of the right lower lobe was detected corresponding to the previous localization of the tip of the Swan-Ganz catheter by contrast-enhanced computed tomography (CT). A subsequent CT showed a marked enlargement of this aneurysm. Therefore, catheter embolization with Gianturco coils and cyanoacrylate glue was successfully performed and resulted in regression of the diameter of the aneurysm (Fig 1).
The patient was successfully discharged and is in excellent condition.
Our review of the literature reveals that this complication isnot rare, especially in elderly patients with fragile pulmonary vessels [2]. Whereas operative procedures carry a high risk, as shown in the article by Sirivella and associates, catheter embolization has been proven to be effective by other groups. We therefore strongly recommend consideration of such treatment in patients in whom enlargement of a false aneurysm is detected [3].
References
- Sirivella S., Gielchinsky I., Parsonnet V. Management of catheter-induced pulmonary artery perforation: a rare complication in cardiovascular operations. Ann Thorac Surg 2001;72:2056-2059.[Abstract/Free Full Text]
- Boyd K.D., Thomas S.J., Gold J., Boyd A.D. A prospective study of complications of pulmonary artery catheterizations in 500 consecutive patients. Chest 1983;84:245-249.[Abstract/Free Full Text]
- Karak P., Dimick R., Hamrick K.M., Schwartzberg M., Saddekni S. Immediate transcatheter embolization of Swan-Ganz catheter-induced pulmonary artery pseudoaneurysm. Chest 1997;111:1450-1452.[Abstract/Free Full Text]
