Swan-Ganz Catheter Placement Research Articles

Evaluation of the concordance between hemodynamic variables obtained by Swan-Ganz catheterization and transthoracic echocardiography in patients after coronary revascularization surgery

Introduction: Currently, there is a trend towards non-invasive hemodynamic monitoring guided by echocardiography, however, in our center, in patients undergoing coronary revascularization surgery, invasive hemodynamic monitoring with Swan-Ganz catheter placement continues. Given that hemodynamic monitoring using non-invasive methods has been shown to be feasible, it is therefore expected that the hemodynamic variables obtained by echocardiography are consistent with the variables obtained by Swan-Ganz catheterization in this type of patient. The objective of the study is to evaluate the concordance that exists between the different hemodynamic variables obtained by Swan-Ganz catheterization, with the variables obtained by echocardiography. Methods: Observational, non-interventional, retrospective, cross-sectional and analytical study, non-randomized. Patients admitted to the Coronary Unit after coronary revascularization surgery were selected, who had a Swan-Ganz catheter on admission, all patients underwent measurement of the hemodynamic variables CO, RAP, PASP, PWP and later TTE was performed to obtain the same variables. Finally, the Concordance Correlation Coefficient described by Lin CCC= (A2+B2-C2) ÷(A2+B2+D2) and by the Bland-Altman method was used as a statistical tool. Results: 26 patients were included, with a mean age of 63.8 ± 6.2 years, 69.2% male. For the CO variable, an average absolute difference of 0.77 L/min and a CCC of 0.7334 were obtained; in the analysis of (B-A), an average difference is -0.4149 L/min. For the RAP an average difference of 2.11 mmHg, with a CCC = 0.8595 and in the analysis of B-A an average difference of -1.11 mmHg. For the PASP an average absolute difference of 5.11 mmHg was obtained with a CCC = 0.5444 and in the B-A analysis an average difference of 0.2944 mmHg. For PWP an average absolute difference of 2.78 mmHg with a CCC = 0.3842, in the analysis of B-A an average difference of 2.13 mmHg. When carrying out the analysis of the average differences obtained from each of the variables, with which a P value of 0.293 was obtained for the CO, 0.129 for the RAP, 0.308 for the PASP, and 0.017 for the PWP. Conclusions: A poor strength of agreement was observed for the CCC for each of the variables, however, these are not clinically significant, so they can be considered as interchangeable methods. It is important to mention that the TTE provides other relevant parameters in the management of these patients.

Preoperative risk factors analysis of pulmonary hypertension crisis during perioperative period for caesarean section of woman with severe pulmonary hypertension

To analyze preoperative risk factors of perioperative pulmonary hypertension crisis (PHC) for pregnant woman with severe pulmonary artery hypertension (PAH), and approach its clinical value. A retrospective analysis was conducted. The clinical data from 152 pregnant women with severe PAH underwent cesarean delivery admitted to Beijing Anzhen Hospital from January 1st 2008 to December 31st 2016 was collected. The patients were divided into two groups according to with perioperative PHC or not. Through the case management system, age, height, weight, gestational age, pregnancy time, type of PAH, emergency or selective surgery, New York Heart Association (NYHA) cardiac function classification, and preoperative ultrasound left ventricular ejection fraction (LVEF), left ventricular diastolic final diameter (LVEDD), the pulmonary artery systolic pressure (sPAP) estimated by ultrasonic TI method, radial artery systolic blood pressure (SBP) and diastolic blood pressure (DBP), heart rate (HR), pulse oxygen saturation (SpO2) without oxygen, oral sildenafil ingestion, having Swan-Ganz catheter placement or not, and whether used norepinephrine or not, as well as the occurrence of perioperative PHC and clinical outcomes were collected. Possible preoperative risk factors were compared between the two groups by single factor and multiple factors logistic regression analysis. The receiver-operating characteristic curve (ROC) was plotted to assess the diagnostic value of various risk factors. A total of 152 patients were screened. Ten patients got heart surgery under general anesthesia at the same time, and 4 patients experiencing cesarean section with general anesthesia were excluded. 138 patients were enrolled finally, 27 patients underwent perioperative PHC (19.57%), and 17 patients died with a mortality of 62.96%. Compared with non-PHC group, the patients in PHC group were older (years: 25.07±3.55 vs. 27.64±4.82), had a poor cardiac function (NYHA cardiac function classification: 3.22±0.64 vs. 2.85±0.53), a smaller LVEDD (mm: 38.78±4.76 vs. 43.91±9.67), lower SpO2 without oxygen (0.83±0.12 vs. 0.92±0.06) and oral sildenafil ingestion rate (29.63% vs. 56.76%), and higher sPAP estimated by ultrasonic TI method [mmHg (1 mmHg = 0.133 kPa): 113.41±24.73 vs. 99.35±21.10] and DBP (mmHg: 79.63±13.23 vs. 75.23±12.14), more having Swan-Ganz catheter placement (85.19% vs. 57.66%), more Eisenmenger syndrome (70.37% vs. 37.84%), and more emergency operation (48.15% vs. 23.42%, all P ≤ 0.1). The variables with statistically significant differences showed by single factor analysis were collected, and it was shown by multiple factors logistic regression analysis that LVEDD [odds ratio (OR) = 0.878, 95% confidence interval (95%CI) = 0.796-0.968, P = 0.009], whether oral taken sildenafil (OR = 0.161, 95%CI = 0.051-0.515, P = 0.002) or not, SpO2 at room air (OR = 0.882, 95%CI = 0.829-0.938, P = 0.000), Swan-Ganz catheter placement or not (OR = 6.186, 95%CI = 1.533-24.964, P = 0.010) were independent risk factors of perioperative PHC in pregnant women with severe PAH. It was shown by ROC curve analysis that the area under the ROC curve (AUC) of four factors mentioned above combined diagnosis for PHC was 0.878 (P = 0.000) with the sensitivity of 88.89% and specificity of 76.58%. PHC is very dangerous for gravida with severe PAH, and the mortality rate is very high. LVEDD, oral sildenafil, SpO2 at room air, Swan-Ganz catheter placement or not were independent risk factors of perioperative PHC for severe PAH maternal. Four preoperative factors of perioperative PHC joint diagnosis accuracy were higher.

Iatrogenic pulmonary artery rupture during Swan–Ganz catheter placement—A novel therapeutic approach

Pulmonary artery rupture (PAR) is a rare but deadly complication (incidence of 0.03-0.2% of all PA cannulations), with mortality in the region of 70%. We report a case of an 88-year-old woman with iatrogenic PAR as a result of Swan-Ganz catheter placement. A rapid successful isolation and occlusion of the culprit PA branch via the deployment of an Amplatzer Vascular Plug (AGA Medical Corporation, North Plymouth, MN) was performed. To our knowledge, this is the first case report where this device has been used as therapy in PAR.

Persistent left superior vena cava identified during central line placement: A case report

INTRODUCTION: A persistent left superior vena cava is found in 0.3-0.5% of the general population and in up to 10% of patients with a congenital cardiac anomaly. It is the most common thoracic venous anomaly and is usually asymptomatic. Being familiar with such anomaly could help clinicians avoid complications during placement of central lines, Swan-Ganz catheters, PICC lines, dialysis catheters, defibrillators, and pacemakers. CASE PRESENTATION: We describe a case of persistent left superior vena cava that was noted after placement of a central line. Mr JJ is a 41 year old African American man who was hospitalized for evaluation and management of alcoholic necrotizing pancreatitis. He required multiple central lines placements. He was noted to have a persistent left superior vena cava that was not recognized initially and thus lead to an unnecessary extra central line placement. DISCUSSION: This anatomic variant may pose iatrogenic risks if it is not recognized by the clinician. A central catheter that tracks down the left mediastinal border may also be in the descending aorta, internal thoracic vein, superior intercostal vein, pericardiophrenic vein, pleura, pericardium, or mediastinum. CONCLUSION: Our case is significant because the patient had two extra central venous catheter placements. This case strongly demonstrates the importance of knowing the thoracic venous anomalies.

Pulmonary Artery Pseudoaneurysm after Swan-Ganz Catheter Placement: Embolization with Vascular Plugs

Three patients who presented with massive hemoptysis after the insertion of a Swan-Ganz catheter for cardiac surgery are reported. Pulmonary artery pseudoaneurysms were diagnosed and successfully treated by embolization with a vascular plug. Follow-up at 15 months showed no recurrence of hemoptysis, and computed tomography helped confirm complete occlusion of the pseudoaneurysms.

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

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. 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 …

Nesiritide Improves Hemodynamics in Children with Dilated Cardiomyopathy: A Pilot Study

This study aimed to obtain hemodynamic measurements of nesiritide in children with dilated cardiomyopathy. A prospective, randomized, double-blinded, placebo-controlled pilot study was conducted in the pediatric intensive care unit at the University of California, Los Angeles. All subjects younger than 21 years admitted to the pediatric intensive care unit with a diagnosis of dilated cardiomyopathy and submitted to cardiac catheterization were randomized to receive either nesiritide or placebo. Right heart catheterization with Swan-Ganz catheter placement was performed. Nesiritide was infused over 24 h. Hemodynamic data were obtained before, during, and after the 24-h nesiritide infusion. The measures obtained included pulmonary capillary wedge pressure (PCWP), central venous pressure, mean pulmonary arterial pressure (MPAP), systolic arterial blood pressure (SBP), cardiac index, and systemic vascular resistance. The study included 20 children: 9 randomized to nesiritide and 11 to placebo. At 24 h, the mean decreases in PCWP, MPAP, and SBP were significantly greater for nesiritide than for placebo: PCWP (-5.3 vs. 1.2 mmHg; p = 0.02), MPAP (-8.0 vs. 0.4 mmHg; p = 0.006), SBP (-7.9 vs. 2.6 mmHg; p = 0.04). Nesiritide significantly decreases PCWP, MPAP, and SBP in children with dilated cardiomyopathy.

Ultrasonographically Guided Percutaneous Embolization of a Pulmonary Pseudoaneurysm

Pulmonary pseudoaneurysms have been described as an unusual complication of Swan-Ganz catheter placement, tuberculosis, bronchiectasis, aspergillomas, and pulmonary hypertension. Untreated, they may lead to life-threatening hemorrhage. Coil embolization to occlude the pseudoaneurysms is the treatment of choice. This report describes a case in which a pulmonary pseudoaneurysm that likely resulted from the previous use of a Swan-Ganz catheter was identified but in which angiography failed to demonstrate a feeding vessel. The pseudoaneurysm was visible by transthoracic ultrasonography because it was surrounded by consolidated lung, possibly related to hemorrhage. Ultrasonography was used to guide puncture of the pseudoaneurysm, and percutaneous coil embolization was performed subsequently. Subsequent angiography and computed tomography demonstrated successful occlusion of the aneurysm. This case illustrates the utility of percutaneous management of pulmonary pseudoaneurysms in certain cases.

Value of Multislice CT in the Diagnosis of Pulmonary Artery Pseudoaneurysm from Swan-Ganz Catheter Placement

Perforation of a pulmonary artery after placement of a Swan-Ganz catheter is a serious complication that requires immediate management. Exact description of size and anatomic localization of a pulmonary pseudoaneurysm is crucial for planning further therapy. This report describes a patient who experienced such a complication, but in whom primary pulmonary angiography failed to demonstrate bleeding. However, multislice computed tomography not only correctly demonstrated the anatomic location of the pseudoaneurysm but was also able to directly visualize the feeder vessel and its connection to the aneurysm. This information was essential for subsequent superselective angiographic visualization of the feeder vessel and for successful embolization as the least invasive method of choice.

Coil Embolization Treatment for Perioperative Pulmanary Artery Rupture Related to Swan-Ganz Catheter Placement

Coil Embolization Treatment for Perioperative Pulmanary Artery Rupture Related to Swan-Ganz Catheter Placement

Impact of Noninvasive Studies to Distinguish Volume Overload From ARDS in Acutely Ill Patients With Pulmonary Edema: Analysis of the Medical Literature From 1966 to 1998

To assess the impact of substituting noninvasive diagnostic studies for Swan-Ganz catheter (SGC) placement in the evaluation of acutely ill patients. Modified decision analysis. Using published studies that define effectiveness of clinical examination, echocardiography, and SGC placement to diagnose pulmonary edema, an analysis of the impact of substituting three diagnostic approaches using (1) clinical assessment (CA), (2) M-mode two-dimensional transthoracic echocardiography (EC), or (3) CA then EC if necessary for SGC placement was considered. Patients with acute respiratory distress and radiographic findings of pulmonary edema, and ICU patients with hypotension and/or pulmonary edema without acute cardiac ischemia. Three approaches using noninvasive studies were substituted for placement of SGC in the initial evaluation of pulmonary edema. The number of SGCs placed, the number of tests needed to diagnose (NTND) all cases of volume overload, and the total number of procedure-related adverse events were calculated for each diagnostic approach and compared to SGC placement. EC, and CA then EC approaches produced fewer procedure-related serious complications and deaths, compared to the SGC approach; however, these approaches also produced a higher NTND and total procedures performed than did the SGC or CA approaches. The CA approach led to reduced NTND and procedure-related adverse events. Substituting noninvasive studies for SGC placement in the initial evaluation of acutely ill patients may slightly reduce procedure-related adverse events, but it may also increase the number of procedures performed. Studies of SGC use are warranted and need to include a clinical assessment control group and an analysis of resource utilization.

False aneurysm of the pulmonary artery induced by a Swan-Ganz catheter: clinical presentation and radiologic management.

This study evaluates retrospectively the clinical presentation, radiographic findings, and angiographic management of false aneurysm of the pulmonary artery resulting from Swan-Ganz catheter placement. Over a 4-year period, seven false aneurysms of the pulmonary artery were diagnosed in five patients (four women, one man) who were 67-81 years old. All five patients underwent Swan-Ganz catheter placement to monitor cardiac surgery--coronary artery bypass grafting in four and mitral valve replacement in one. All patients were anticoagulated. For five patients, we reviewed the medical records and the results of chest radiography, digital subtraction pulmonary angiography, and pulmonary artery embolization. For two patients, we reviewed the results of CT scanning. Non-life-threatening hemoptysis was noted in all cases and occurred in three patients after the Swan-Ganz catheter had been removed (elapsed time of 1-19 days). Chest radiographs revealed a pulmonary infiltrate in one patient and a pulmonary mass in two patients. The results were unremarkable in the other two patients. CT depicted two false aneurysms of the pulmonary artery as round masses with eccentrically enhanced lumina circumscribed by thrombosis. Pulmonary angiography revealed a single false aneurysm in three patients and two false aneurysms in two patients. All false aneurysms were localized in segmental or subsegmental branches of the right middle pulmonary artery (n = 4) or the right lower pulmonary artery (n = 3). All patients were successfully treated with transcatheter steel-coil embolization. Even when the chest radiograph appears unremarkable, patients clinically suspected of developing a false aneurysm of the pulmonary artery after Swan-Ganz catheter placement require enhanced CT or pulmonary angiography to establish the diagnosis. False aneurysms of the pulmonary artery can be treated at the time of pulmonary angiography by steel-coil embolization.

Inferior vena caval blood flow and cardiac hemodynamics during carbon dioxide pneumoperitoneum

The effects of carbon dioxide pneumoperitoneum on venous return and cardiac hemodynamics during laparoscopic surgery were studied. Twelve adult pigs underwent placement of an electromagnetic flow meter across the infrarenal vena cava (IVC) as well as placement of Swan Ganz and arterial monitoring catheters. Measurements of the flow through infrarenal IVC, cardiac output (CO), pulmonary capillary wedge pressure (PCWP), mean arterial pressure (MAP), and heart rate were recorded at baseline, 5 and 60 min following insufflation to 15 mmHg with CO2, and 5 min following desufflation. Stroke volumes and systemic vascular resistance (SVR) were calculated as well. Flow through the IVC dropped by 24 and 31% at 5 and 60 min (p = 0.03 and 0.02, respectively). Paradoxically, cardiac output rose by 14 and 28% at 5 and 60 min (p = 0.03 at 60 min). Central venous and pulmonary capillary wedge pressures rose transiently by 35 and 36% at 5 min before returning to baseline (p < 0.01). Mean arterial pressure and heart rate remained relatively constant during insufflation. Systemic vascular resistance diminished from 938 dynes/cm/s prior to insufflation to its nadir at 60 min of 650 dynes/cm/s (p < 0.01). These observations suggest potentially complex interactions between the mechanical and systemic effects of the CO2 pneumoperitoneum on venous return. Transient elevations in cardiac filling pressures occur by an unknown mechanism, and a generalized enhanced inotropic state mediated via increased sympathetic outflow is observed in this hypercapnic anesthetized animal model.

Overfeeding in a patient with kwashiorkor syndrome

The patient was a 56-y-old white female admitted on October 21, 1995, for acute abdominal pain with an ultimate diagnosis of mesenteric ischemia and gangrenous cholecystitis. She subsequently underwent a cholecystectomy and small and large bowel resection with a jejunocolostomy. On admission she was 5 ‘5” ( 165 cm), 102 pounds (46.3 kg), with an ideal body weight of 125 pounds. An albumin level done postoperatively was 2.6 g/dL. Postoperatively she was ventilator-dependent and had an ileus. She was started on 1000 kcaYd of total parenteral nutrition (TPN) which included 19% of calories as protein (47.5 g/d). On October 24 and 25, she became febrile and was re-explored to rule out ischemic small bowel. Upon re-exploration, no necrotic small bowel was found. On October 26, she extubated herself and was ultimately transferred to the ward. Her TPN was increased to 1600 kcal/d, 19% of calories as protein (76 g/d). She did well until October 31, when she developed two fistulas through her abdominal wound. She was kept NPO, the TPN was continued, and somatostatin was begun. Because she was felt to be hypermetabolic, her TPN was increased to 1800 kcaYd with 24% of calories as protein (108 g/d). Laboratory values revealed a total protein level of 5.3 g/dL and a serum albumin level of 1.8 g/dL. She was continued on 1800 kcalld of TPN with 24% of calories as protein through November 21, with intermittent spiking fevers (no source was identified). Hypomagnesemia developed ( 1.5 g/dL), but the remainder of the electrolytes and Ca, PO4 were all normal. The patient’s serum albumin level on November 22 was 2.0 g/dL. Her TPN was subsequently increased to 2200 kcal/d with 24% of that amount provided as protein ( 132 g/d), under the housestaff impression that her energy needs had not been met. On November 27 she became hypercapneic and tachycardic and was transferred to the SICU with ventilatory failure and atria1 fibrillation with a rapid ventricular response rate. Laboratory values at the time of transfer revealed: Na = 140 n-Q/L, K = 4.1 mEq/L, Cl = 105 mEq/L, HCOs = 25 mEq/L, blood urea nitrogen (BUN) = 29 mg/dL, Crt = 0.9 mg/dL, Glucose = 292 mg/dL, Ca = 7.9 mg/dL, PO, = 4.1, Mg = 2.1 mg/ dL, and Albumin = 2.6 g/dL. She subsequently underwent Swan-Ganz catheter placement with cardiac output = 4.5 L/ min, C.I. = 3.2 L * min-’ * m2 -I, SVR = 1400 dyne-set/cm-5, PA = 44126 mmHg, CVP = 21 mmHg, and PCWP = 22 mmHg. Arterial blood gases on 80% FI02 assist control ventilation (A/C) were pH 7.49, Paco2 = 35 mmHg, and Pa02 = 98 mmHg. She was started on broad-spectrum antibiotic coverage. Her subsequent hospital course was complicated by sepsis, congestive heart failure, and rapid ventricular-response atria1 fibrillation, which did not respond to a diltiazem drip (rate = 135 beats/mm). An echocardiogram revealed a normal left ventricular size, left ventricular hypokinesis, a mildly dilated left atrium, and moderate mitral and tricuspid regurgitation. She was started on digoxin without apparent response.

Maternal and fetal effects of laparoscopic insufflation in the gravid baboon

To test the hypothesis that intraabdominal pressures (IAP) associated with abdominal insufflation for laparoscopic procedures can alter pulmonary and hemodynamic values in the pregnant baboon and hemodynamic values in the fetus. A descriptive physiologic study. Animal research facility at Scott and White Memorial Hospital, Temple, TX. Four pregnant baboons at 120 +/- 7 days' gestation. The baboons underwent general anesthesia, Swan-Ganz and arterial catheter placement, and abdominal insufflation at 10 and 20 mm Hg IAP for 20-minute intervals at each pressure. The following end points were measured: maternal heart rate (MHR), mean arterial pressure (MAP), cardiac output (CO), pulmonary capillary wedge pressure (PCWP), pulmonary artery pressures (PAP), central venous pressure (CVP), systemic vascular resistance (SVR), ventilator rate (VR), oxygen saturation, and end-tidal carbon dioxide (CO2). Fetal heart rate and fetal growth values were measured, and umbilical artery Doppler flow studies were performed. The PCWP (p <0.026), CVP (p <0.0012), and PAP (p <0.046) were significantly increased at 20 mm Hg IAP; CO decreased as IP increased. The MAP, MHR, and SVR did not change significantly with increased IAP. The only significant change in pulmonary values was the increase in peak airway pressure (p <0.001). The VR was increased from an average of 18 to 41 breaths/minute in an attempt to maintain adequate oxygen saturation and to normalize end-tidal CO2 when IAP was increased to 20 mm Hg. Respiratory acidosis (pH <7. 35, partial pressure of carbon dioxide >50 torr) was demonstrated in three of four animals within 20 minutes at an IAP of 20 mm Hg. Results of Doppler flow studies on the effects of the fetuses were unaltered immediately after this procedure compared with baseline measurements. Normal interval growth was demonstrated 2 weeks after the procedure. The baboon mothers and fetuses had no adverse effects at an IAP of 10 mm Hg, but may have significant cardiovascular and respiratory alterations associated with IAP of 20 mm Hg.

Failure of Physiologic Parameters as Predictors of Acute Upper Airway Obstruction

At the recent spring meeting of the American Broncho-Esophagological Association in San Francisco, Calif, Drs Eisele, Coltrera, Bright, and Weymuller, all from Seattle, Wash, presented a paper on physiologic changes during acute upper airway obstructions. Their goals included (1) to develop an awake animal model of variable upper airway obstruction with the airway intact, (2) to measure airway resistance, and (3) to use the animal model to evaluate acute airway obstruction. Their experimental design called for the use of a goat and the placement of Swan-Ganz catheters into the trachea transcutaneously. With these catheters in place and an airtight mask over the animal's face, a pneumotachometer was used to collect data. Other physiologic parameters that the investigators monitored included blood pressure, heart rate, electrocardiogram, respiratory rate, arterial blood gases, and physical examination changes. Using variable degrees of acute airway obstruction, the investigators found no consistent physiologic parameter changed, except for

Chest x-ray as an aid in troubleshooting Swan-Ganz catheter placement.

Chest x-ray as an aid in troubleshooting Swan-Ganz catheter placement.

Catheter introducers for rapid fluid resuscitation

Catheter introducer sets developed for placement of Swan-Ganz catheters are useful as temporary large-diameter lines in hypovolemic patients. The internal diameters of 8 F introducers exceed the diameter of standard intravenous tubing. We compared an 8 F introducer to other catheters and found the introducer had a significantly faster flow rate than did a 14-gauge cannula (P less than .05). Introducers were placed successfully, without any serious complications, in 42 of 47 severely ill patients. Because catheter introducers may be inserted percutaneously into any large vein above or below the diaphragm, they are ideal for rapid fluid resuscitation.

Renovascular hypertension in the patient with severe atherosclerosis.

From 1976 to 1981, 22 patients were treated for atherosclerotic renovascular disease and with widespread atherosclerosis. The average age was 56 years. Preoperatively, the average blood pressure (BP) was 211/123 mm Hg. The standard operation was aortorenal bypass, associated with resection of an abdominal aortic aneurysm in three cases. Four patients had nephrectomy. Most patients were referred after failure of a previous renal revascularization procedure. In three patients, most of the renal arterial system was thrombotic. All patients had preoperative Swan-Ganz catheter placement for monitoring of fluid balance, filling pressure, and cardiac output. Intravenous vasodilators were used to control BP and to reduce the afterload on the left ventricle. There were no operative deaths. The average postoperative BP was 136/81 mm Hg. Three patients had improvement in renal function, and one was able to stop hemodialysis after operation. Because of a low mortality and overall satisfactory results, patients with atherosclerotic renovascular hypertension should be considered for vascular reconstruction.

Air Embolization during Percutaneous Swan-Ganz Catheter Placement

Air Embolization during Percutaneous Swan-Ganz Catheter Placement