PERCUTANEOUS RETRIEVAL OF THE SUTURE-ENTRAPPED SWAN-GANZ CATHETER

TOPIC: Cardiothoracic Surgery TYPE: Fellow Case Reports INTRODUCTION: Pulmonary artery catheters (PAC) are used in cardiac surgery to provide critical clinical data. While safe, they not harmless with multiple associated risks, including surgical entrapment. Causes of include suture snaring and PAC knotting. We present the case a surgically entrapped that was successfully removed percutaneous fashion. CASE PRESENTATION: A 61-year-old man MV regurgitation presented for repair. PA catheter placed through an 8-FR sheath RIJ vein. Sternotomy performed patient on central cardiopulmonary bypass bicaval venous cannulation. The LA entered inter-atrial groove, repair performed. Following both atriotomy closure decannulation, anesthesia team reported seamless mobility chest closed. On POD1, removal met resistance. Imaging confirmed normal position without obvious taken IR suite where fluoroscopy revealed tethering at inferior third SVC. proximal aspect then cut indwelling replaced 9-FR braided over PAC, which served as 'guide-wire'. point obstruction detected by tactile sensation. upsized 10-FR vascular sheath. With gentle, simultaneous, back-and-forth maneuvering sheath, liberated removed. Superior venacavogram brisk flow contrast SVC, RA pulmonary outflow tract no evidence injury. Mediastinal tubes were POD2 discharged POD5. DISCUSSION: PACs data help guide therapy. In review 15,000 patients, Kaplan et al low risk their use entrapment constituting only 0.065%-0.1% cases. most common sites around atrio-caval site. re-do sternotomy has been traditional approach retrieval, it carries inherent risks. Percutaneous options can be considered if offending is sufficiently loose perforated PAC. This must controlled environment appropriate resources available sternotomy. Clinical surveillance repeat TTE 24-HR critical. Ultimately prevention best therapy heightened vigilance during avoid CONCLUSIONS: sense recognition key management Sensible planning, cautious instrumentation attentive post-procedure assessment all successful outcome. unfortunate situation this complication does occur, recovery viable safe option consider discussed our report. REFERENCE #1: consider. #2: Pfeiffer K, Widmann M, Deusch H, Guggenberger Duda S, Seboldt H. Inadvertant fixation Swan-Ganz following heart surgery. Anaesthetist. 1995;44:782–4 #3: Demirtas Cimen al. Catheter Entrapment Open Heart Surgery. J Cardiothorac Surg. 2000;15:313-315. DISCLOSURES: No relevant relationships Roger Goldman, source=Web Response Consultant relationship Medtronic Please note: 5 years Added 02/16/2021 Bob Kiaii, Response, value=Honoraria Johnson 3 Years Boston Scientific 4 Edwards Life Sciences Medical Advisor Abbott 6 months David Li, AMIR SARKESHIK,