Inadvertent fracture during the attempted removal of entrapped Swan-Ganz catheter.

Dear Editor, Pulmonary artery catheter is widely used in cardiovascular surgical practice. Various complications of the Swan-Ganz catheter during insertion, its long-term placement, or removal are well known since its introduction.1-5 Herein, we report a case of the inadvertent fracture of an entrapped Swan-Ganz catheter during its attempted removal with moderate external traction. A 36-year-old man was admitted to our hospital with symptoms of increasing dyspnoea on exertion, fatigue and palpitation for several months. Physical examination, echocardiographic study and cardiac catheterisation showed severe mitral and aortic valve disease. He underwent the operation and a 7 F 110 cm long Swan-Ganz thermodilution catheter (Edwards Lifesciences LLC, Irvine, USA) was easily inserted through a percutaneous haemostasis sheath introducer (8.5 F Fast-CathTM, St. Jude Medical, MN) via the right internal jugular vein. It was successfully guided into the pulmonary artery. There was no immediate complication during the insertion of the catheter. Aortic and mitral valve replacement with mechanical prosthetic valves (St. Jude Valve, St. Jude Medical Inc., St. Paul, MN) were then performed. Throughout the operation, the Swan-Ganz catheter functioned well and haemodynamic data were obtained intraoperatively without problems. After an uneventful surgery, the patient was transferred to the surgical intensive care unit. The postoperative chest radiography showed the Swan-Ganz catheter in its usual pattern. Twelve hours after the operation, the patient was extubated smoothly. Four hours later, when he was haemodynamically stable, we tried to remove the Swan-Ganz catheter. During the attempted removal, we noted resistance and were unable to remove the catheter. Chest radiography revealed a normally positioned catheter in the right atrium with the distal portion in the right pulmonary artery. Further attempts with moderate external traction to remove the Swan-Ganz catheter immediately resulted in its fracture at the 40th cm. Chest radiography revealed the proximal end of the fractured catheter within the right atrium (Fig. 1). The patient was brought to the angiography suite where attempts at looping the free end of the catheter and pulling it by using a 0.14 long guidewire catheter (Boston Scientific, Scimed) by the cardiologist was unsuccessful. We suspected that the catheter was probably entrapped in the left atrial Inadvertent Fracture During the Attempted Removal of Entrapped Swan-Ganz Catheter