Right Ventricular Perforation Caused by Pulmonary Artery Catheter Three Days after Insertion in a Patient with Acute Pulmonary Embolism

A 68 year-old man presented with dyspnoea and chest pain. Computed tomography showed a massive bilateral pulmonary embolism. A 7.5 French pulmonary artery catheter (PAC) was inserted from the right internal jugular vein, and placed at the main pulmonary artery (PA) due to a thrombus in the distal PA. Continuous heparin sodium and urokinase infusions (240,000 units/day) were started. The PA pressure decreased gradually to within the normal range after two days. Three days after insertion, the PA waveform suddenly changed, he subsequently complained of chest pain, and the blood pressure rapidly decreased. Echocardiography demonstrated marked pericardial effusion. Computed tomography showed right ventricular perforation by the catheter, and contrast dye injection from the catheter tip demonstrated pericardial space enhancement. A median sternotomy was performed, and the perforation was detected in the anterior right ventricular wall. Direct buttress suture was placed, and the catheter was removed. He was subsequently discharged without any further complications. We encountered a rare case of postoperative RV perforation caused by a PAC. It is important to keep in mind that such a complication could arise not only during but also a few days after PAC insertion. (C) 2013 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier Inc. All rights reserved.