Right Atrial, Right Ventricular, Superior Vena Cava Dissection Caused by Swan-Ganz Catheter Placement

J INVASIVE CARDIOL 2019;31(5):E95.

Key words: echocardiogram, dissection

A 62-year-old male with an abnormal stress test underwent stent placement of the left anterior descending coronary artery. Soon after, this was complicated by stent thrombosis leading to cardiogenic shock that was refractory to pressors, requiring intra-aortic balloon placement. The patient was eventually weaned off pressors and ventilatory support, but developed septic shock secondary to hospital-acquired pneumonia, and shortly thereafter developed cardiogenic shock. A Swan-Ganz catheter was then placed with the aide of an Arrow Spring-Wire guide (Teleflex), marked 0.035˝ diameter x 17-3/4˝ with an Arrow Advancer (Teleflex). The patient remained hemodynamically stable throughout the procedure. Transesophageal echocardiography was then performed after placement to rule out any cardiogenic abnormalities contributing to the presentation. Results demonstrated a right atrial dissection with extension into the superior vena cava and right ventricle not seen on previous echocardiographic findings (Figures 1 and 2). No intervention was performed as the patient’s hemodynamic status improved. We propose that during Swan-Ganz catheter placement, the guidewire sheared the intimal lining of the superior vena cava and endocardium.

From the ¹Department of Anesthesia, Mount Sinai Medical Center, Miami Beach, Florida; and ²Echocardiography Laboratory, Columbia University Division of Cardiology at the Mount Sinai Heart Institute, Miami Beach, Florida.

Disclosure: The authors have completed and returned the ICMJE Form for Disclosure of Potential Conflicts of Interest. The authors report no conflicts of interest regarding the content herein.

The authors report that patient consent was provided for publication of the images used herein.

Manuscript accepted November 6, 2018.

Address for correspondence: Orlando Santana, MD, Director, Echocardiography Laboratory, Columbia University Division of Cardiology, Mount Sinai Heart Institute, 4300 Alton Road, Miami Beach, FL 33140. Email: osantana@msmc.com