Anesth Analg 2003;97:606-607
© 2003 International Anesthesia Research Society
LETTERS TO THE EDITOR
Pulmonary Artery Catheter Sutured to Pulmonary Artery Trunk During Cardiac Surgery
Masato Hosoya, MD,
Shinichi Inomata, MD,
Iwao Sukegawa, MD,
Shigeyuki Saito, MD, and
Hidenori Toyooka, MD
Department of Anesthesiology, University of Tsukuba, Tsukuba, Ibaraki, Japan
To the Editor:
We report a case of accidental suture of the pulmonary artery (PA) catheter to the pulmonary arterial trunk while inserting a PA vent tube to decompress the left heart. One day after the surgery, the patient had to receive an additional surgery to remove the PA catheter from the PA trunk.
A 56-yr-old man underwent coronary artery bypass surgery with a continuous cardiac output (CO) PA catheter (CCO/SvO2 thermodilution catheter). During cardiopulmonary bypass, blood leaking was noted in the syringe for balloon inflation and around the connection at the optical module from the fiberoptic SvO2 port of the PA catheter. The fiberoptic continuous monitoring of SvO2 and CCO was still possible to measure. The surgeon decided to remove the PA catheter in the ICU after the surgery, but resistance was noted. We confirmed that the tip of the PA catheter was fixed in the PA under fluoroscopy. It was suspected that the PA catheter had been sutured to the PA trunk, and therefore the patient was sent to the operating room for further surgical removal. Under general anesthesia, the sutures securing the left heart vent hole on the pulmonary trunk were released, and then the catheter was pulled back without resistance. Figure 1 shows the PA catheter that was removed.
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Figure 1. Distal portion of PA catheter that was removed from the patient. A suture has been placed through the hole created by the vent stitch. At the additional operation, the vent stitch was cut, resulting in immediate freedom of the PA catheter. A needle hole was situated at 8 cm from the tip.
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We should have figured out that the PA catheter was damaged by the needle thread and should have confirmed the mobility of the PAC tip before closing the chest (1). If the PAC is pulled up forcibly despite resistance, damage to the sutured blood vessel may occur (2). The PA catheter that we used this time was confirmed structure from the section (Fig. 2). The balloon-inflating lumen was communicated with an optical (Svo2) fiber lumen. The metal wire was not damaged, and therefore the Svo2 kept functioning. The optical fiber was functioning well but the pulmonary capillary wedge pressure was not obtained following balloon inflation. However, blood came out to the proximal to the proximal end of the optical module, probably around the optical fiber. In addition, the fact that blood was aspirated into a syringe attached to the balloon-inflating lumen corroborated the speculation above.
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Figure 2. Chart showing a cross section of PA catheter. The rent stitch ran through the lumen of the SvO2 module and the lumen of the balloon without cutting the electric line.
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In conclusion, it is advisable to ascertain that the PA catheter is freely mobile and its functions are not impaired before terminating cardiopulmonary bypass, since this simple maneuver may allow an early detection of this rare complication.
References
- Inomata S, Nishikawa T. Bleeding from the SvO2 monitoring port of PA catheter during cardiac surgery. Can J Anaesth 1994; 41: 877–878.[Free Full Text]
- Huang GH, Wang HJ, Chen CH, et al. Pulmonary artery rupture after attempted removal of a pulmonary artery catheter. Anesth Analg 2002; 95: 299–301.[Abstract/Free Full Text]
