Pulmonary artery catheter knotting: are conservative measures always successful? a case report
Keywords:Coronary artery bypass, Knot, Tricuspid valve
Pulmonary artery catheter (PAC) or Swan-Ganz catheter is a flow directed balloon tipped catheter routinely used in patients undergoing Coronary Artery Bypass Grafting (CABG). The reported rate of complications with PAC is 3-17% including arrhythmias, pneumothorax, pulmonary embolism, bacteraemia and death1. Knot formation is an uncommon complication of PAC and is usually managed conservatively2. Here we report about a patient with knotted PAC who required operative intervention after failure of conventional measures as the knot engulfed the tricuspid valve chordae and was fixed.
Akhtar MI, Hamid M, Khan FH, Naqvi HI, Gangwani A. Pulmonary artery catheter knotting in a coronary artery bypass surgery patient. J Pak Med Assoc 2007;57:519-21.
Lopes MC, de Cleva R, Zilberstein B, Gama-Rodrigues JJ. Pulmonary artery catheter complications: report on a case of a knot accident and literature review. Rev Hosp Clin Fac Med Sao Paulo. 2004;59:77-85.
Karanikas ID, Polychronidis A, Vrachatis A, Arvanitis DP, Simopoulos CE, Lazarides MK. Removal of knotted intravascular devices. Case report and review of the literature. Eur J Vasc Endovasc Surg. 2002;23:189-94.
Georghiou GP, Vidne BA, Raanani E. Knotting of a pulmonary artery catheter in the superior vena cava: surgical removal and a word of caution. Heart. 2004;90:e28.
Baker BM. Occurrence and removal of a knotted pulmonary artery catheter: a case report. AANA J. 2007;75:423.
Ishaq M, Alexander N, Scott DH. Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus. Saudi J Anaesth. 2013;7:191-3.