The Swan-Ganz catheter in the cardiac laboratory.

In I970, Swan and associates reported on their results in catheterization of the right heart with a soft, flow-directed, balloon-tipped catheter of their design. Using the 5F size catheter the pulmonary artery was rapidly and safely catheterized in 95 per cent of patients in intensive care situations without the aid of fluoroscopy. The availability of the Swan-Ganz catheter (Edwards Laboratories, 624 Dyer Road, Santa Ana, California) has led to a change in our approach to cardiac catheterization, and the purpose of this report is to describe our experience with this catheter in routine cardiac catheterization in the cardiovascular laboratory. In the sicker patient, particularly when the right atrium is enlarged, the performance of a right heart catheterization represents in many cases the most hazardous part of the procedure when carried out with orthodox, semi-rigid catheters such as the Cournand or Lehman catheter. The reason for this is the need to form a loop by pushing the catheter against the right atrial wall. Not infrequently this manoeuvre leads to supraventricular tachycardia, and in a proportion of these the whole study is jeopardized or abandoned. Further, frightening ventricular arrhythmias are frequently precipitated by semi-rigid catheters impinging against the right ventricular endocardium. It has, therefore, become our policy to practise and teach that when the important data required are those from the left heart (e.g. coronary arteriography, aortic valve function) the right heart catheter should not be advanced beyond the superior vena cava until the relevant left-sided data have been obtained. With the advent of the Swan-Ganz catheter,