Abstract
Pulmonary vascular injury is a rare but life-threatening complication of Swan-Ganz catheterization. We report an 82-year old patient who underwent right heart catheterization by a balloon-tipped catheter because of suspected pulmonary hypertension. After deflation of the catheter in the wedge position, hemoptoe appeared associated with acute respiratory insufficiency requiring respiratory support by intubation and mechanical ventilation. Pulmonary angiography showed the formation of a false aneurysm of a segment artery of the left lower lobe. Immediate interventional therapy was performed by the implantation of two coated coronary stent grafts into the injured pulmonary artery thereby excluding the false aneurysm. Bleeding was stopped by this interventional approach while antegrade blood flow was maintained. Long term follow-up after 3 months showed an effective treatment with a completely thrombotic false aneurysm. However, despite oral anticoagulation and dual antiplatelet therapy, graft patency could not be achieved after 3 months. In summary, implantation of coated stents is a feasible and safe approach for the acute and long term treatment of potentially life-threatening condition of a pulmonary artery false aneurysm while treatment to achieve long term patency of the affected vessel still remains an issue to be resolved.
Highlights
Swan-Ganz catheter has been widely used for the diagnosis of pulmonary hypertension as well as hemodynamic monitoring in intensive care medicine or perioperative management for many decades
Age >60 years Female sex Pulmonary hypertension Coagulation disorders Systemic anticoagulation Long term steroid use Surgically induced hypothermia Cardiac decompression Cardiac manipulation during surgery manoeuver stabilizes hemoptoe; selective pulmonary angiography via Swan-Ganz catheter revealed a false aneurysm of a segment artery of the left lower lobe (Figure 1)
Despite oral anticoagulation and dual antiplatelet therapy (DAPT), the vessel was shown to be occluded in the 3-month follow-up without clinical symptoms of pulmonary embolism
Summary
Swan-Ganz catheter has been widely used for the diagnosis of pulmonary hypertension as well as hemodynamic monitoring in intensive care medicine or perioperative management for many decades. It seems to be a safe procedure, pulmonary artery injury occurs in 0.03%–0.47% [1,2,3]. Pulmonary artery injury is a severe, life-threatening complication with high mortality of more than 50% [2, 3]. Cardiologists and intensive care physicians should be aware of the symptoms of pulmonary artery injury and should define potential treatment strategies
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