Perforation of the pulmonary artery requiring pneumonectomy after the use of a flow-directed (Swan-Ganz) catheter.

A case of pulmonary artery perforation by a flow-directed balloon-tipped catheter necessitated pneumonectomy. Predisposing conditions are discussed and conclusions made on the basis of this case and previous reports. The flow-directed balloon-tipped catheter has been widely used in cardiac surgical patients (Katz et al, 1977) in patients undergoing major surgical procedures and in emergencies for critically ill patients requiring assessment and management for cardiopulmonary deterioration or disturbances of fluid balance or both (Swan and Ganz, 1975). At Yale these catheters are used routinely in patients undergoing cardiac surgical procedures. Over 2000 such catheters have been inserted resulting in considerable experience in their placement. Immediate complications include arrhythmias, carotid artery puncture, and pneumothorax. Long-term complications include sepsis, pulmonary infarction, and neuropathy (Katz et al, 1977). The common complications associated with their insertion are usually not severe and have not been associated with lethal consequences (Foote et al, 1974; Katz et al, 1977). Major complications have been described, among which are five cases of pulmonary artery perforation, two of them fatal (Chun and Ellestad, 1971; Lapin and Murray, 1972; German et al, 1973; Golden et al, 1973; Page