Simultaneous excision of bilateral neurogenic tumors of the mediastinum.

CHEST,VOL.62, NO. 3, SEPTEMBER, 1972 lower lobe pulmonary vein into the left atrium, the catheter became trapped and looped at the level of the atrial septal defect; injection of contrast material revealed its tip to be floating free]y in the left atrium (Fig 1). Attempts at extrication involved the use of guide wires in ax,effort to straighten the catheter, pressure injections of saline solutions to dislodge the trapped portion, and amyl nitrate inhalation to relax possiblevascular spasmassociated with the entrapment. Simple traction on the catheter was without result, and produced considerable chestpain. Becausethe exactsite and cause of entrapment was unknown, the catheter was left in place, and connected to a rapidly flowing heparinized saline infusion in order to prevent thrombus formation within the catheter. Continuous overnight traction was applied to the catheter by means of a specially designed weighted pulley system,and was of no avail. On the following day, another attempt to remove the catheter under fluoroscopic control was unsuccessful. As the hemodynamic data indicated a significant left-toright shunt, and as the catheter could not be extricated, thoracotomywas performed on the third post-catheterization day. With the patient under fufl cardiopulmonary bypass, right atriotomy was made.The tip of the Cournand catheter was discovered to be curled upon itself and caught in the strands ofaChiari network in theatrial septum (Fig 2).The Chiari strands, together with the catheter, were excised and the atrial septal defect closed by direct suture. There wereno complications.