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LETTER TO THE EDITOR

Pulmonary Artery Catheter Misplacement

Department of Anaesthetics; Nottingham City Hospital; Nottingham, United Kingdom; ptewari123{at}yahoo.co.in

To the Editor:

Matyal et al. (1) describe the use of transesophageal echocardiography to detect misplacement of a pulmonary artery (PA) catheter in the coronary sinus. After misdirection of a PA catheter, it is important to reposition the patient with the right side up when crossing the tricuspid valve, and the left side and head up when crossing the pulmonic valve, permitting the balloon to float to PA (2,3).

I do not agree with the authors’ speculation that elevated central venous pressure dilates the coronary sinus, particularly with posteriorly directed tricuspid regurgitation jets. Mahmud et al. (4) reported in their study of coronary sinus dilation in patients with chronic pulmonary hypertension that the coronary sinus is not affected by tricuspid regurgitation jet.

REFERENCES

1. Matyal R, Mahmood F, Panzica P, et al. Inadvertent placement of a flow-directed pulmonary artery catheter in the coronary sinus, detected by transesophageal echocardiography. Anesth Analg 2006;102:363–5.[Abstract/Free Full Text]
2. Szabo Z. A simple method to pass a pulmonary artery floatation catheter rapidly into the pulmonary artery in anaesthetized patients. Br J Anaesth 2003;90:794–6.[Abstract/Free Full Text]
3. Parlow JL, Milne B, Cervenko FW. Balloon flotation is more important than flow direction in determining the position of flow-directed pulmonary artery catheters. J Cardiothorac Vasc Anesth 1992;6:20–3.[Medline]
4. Mahmud E, Raisinghani A, Keramati S, et al. Dilation of the coronary sinus on echocardiogram: prevalence and significance in patients with chronic pulmonary hypertension. J Am Soc Echocardiogr 2001;14:44–9.[Web of Science][Medline]

This article has been cited by other articles:

				R. Matyal, F. Mahmood, P. Panzica, J. Mitchell, and A. Lerner Pulmonary Artery Catheter Misplacement Anesth. Analg., February 1, 2007; 104(2): 456 - 457. [Full Text] [PDF]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a colleague Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Web of Science (1) Citing Articles via Google Scholar Google Scholar Articles by Tewari, P. Search for Related Content PubMed PubMed Citation Articles by Tewari, P.