Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 620
Filtrar
2.
Crit Care Nurs Clin North Am ; 31(3): 329-348, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31351554

RESUMO

The hemodynamic monitoring landscape is rapidly evolving from pressure-based and static parameters to more blood flow-based and dynamic parameters. Consensus guidelines for cardiac surgery state that the pulmonary artery catheter is neither required nor helpful in most patients. In the meantime, critical care has been searching for the alternatives to the pulmonary artery catheter and protocols for use. Best available evidence for any protocol developed suggests the inclusion of stroke volume optimization to determine fluid responsiveness. Additional strategies to using stroke volume to optimize hemodynamics, including case studies, are discussed.


Assuntos
Algoritmos , Procedimentos Cirúrgicos Cardíacos/reabilitação , Volume Sistólico/fisiologia , Cateterismo de Swan-Ganz/efeitos adversos , Enfermagem de Cuidados Críticos , Humanos
3.
A A Pract ; 13(5): 181-184, 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31162226

RESUMO

Placement of a pulmonary artery catheter (PAC) is associated with complications such as entrapment or knotting. PAC entrapment in the heart, vena cava, or pulmonary artery is serious, potentially life-threatening, particularly if they are unrecognized. We present a patient with a PAC knot after aortic valve replacement. Interventional radiology (IR) determined that the catheter may have lodged in the tricuspid valve. Surgical exploration requiring cardiopulmonary bypass revealed that the PAC had passed through the tricuspid valve orifice and knotted itself around the anterior leaflet chordal structure. The catheter was unknotted, with the patient subsequently recovering without long-term sequelae.


Assuntos
Estenose da Valva Aórtica/cirurgia , Ponte Cardiopulmonar/métodos , Cateterismo de Swan-Ganz/efeitos adversos , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Procedimentos Cirúrgicos Eletivos , Próteses Valvulares Cardíacas , Humanos , Masculino , Resultado do Tratamento , Valva Tricúspide/diagnóstico por imagem , Insuficiência da Valva Tricúspide/etiologia
4.
J Invasive Cardiol ; 31(5): E95, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31034443
5.
Ann Intern Med ; 169(9): 636-642, 2018 11 06.
Artigo em Inglês | MEDLINE | ID: mdl-30398637

RESUMO

Jeremy Swan and William Ganz developed their eponymous pulmonary artery (PA) catheter in the 1970s and, in the process, revolutionized measurement of cardiac output, pressures within the left side of the heart, and resistance in systemic and pulmonary circulations. Their invention enabled diagnostic measurements at the bedside and contributed to the birth of critical care medicine; technologic advances preceding the PA catheter generally could not be used at the bedside and required patients to be stable enough to be taken to the catheterization laboratory. Swan and Ganz worked in the same department but had quite dissimilar backgrounds and personalities. This article describes their lives and careers, the state of intensive care before and after their catheter was introduced, and the natural life cycle the PA catheter faced as new, less invasive technology arrived to replace it.


Assuntos
Cateterismo de Swan-Ganz/história , Procedimentos Cirúrgicos Cardíacos/história , Cateterismo de Swan-Ganz/efeitos adversos , Cuidados Críticos/história , Tchecoslováquia , Inglaterra , História do Século XIX , História do Século XX , História do Século XXI , Humanos , Los Angeles
6.
Pediatr Cardiol ; 39(6): 1236-1241, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29744656

RESUMO

Recent advances in the field of pediatric interventional cardiology have resulted in therapies for patients in need of augmented pulmonary artery (PA) flow. Catheter-based PA rehabilitation can be performed safely but not without the potential risk of pulmonary hemorrhage. When severe, this bleeding has the ability to contaminate the bronchi and trachea, and possibly occlude the endotracheal tube. This can result in a critical inability to ventilate and oxygenate these patients. Herein, we review our institutional experience with pulmonary hemorrhage associated with these procedures and the feasibility of predicting this outcome. The secondary aim was to discuss our novel anesthetic approach to a select group of these patients, involving the use of bronchial blockers to preemptively prevent contamination of bilateral bronchi and occlusion of the endotracheal tube.


Assuntos
Cateterismo de Swan-Ganz/efeitos adversos , Cardiopatias Congênitas/cirurgia , Intubação Intratraqueal/efeitos adversos , Artéria Pulmonar/lesões , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Artéria Pulmonar/diagnóstico por imagem , Estudos Retrospectivos
8.
Ann Vasc Surg ; 50: 8-14, 2018 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-29455018

RESUMO

BACKGROUND: To evaluate the safety and efficacy of selective catheter-directed thrombolysis (SCDT) in treating acute massive pulmonary thromboembolism (AMPTE). METHODS: Twenty-six AMPTE patients were enrolled between March 2010 and March 2013. A Uni*Fuse infusion system was inserted into the main pulmonary artery thrombus. The thrombolytic regimen included an intraoperative bolus injection of 250,000 IU urokinase, followed by continuous thrombolytic infusion of 5,000 IU/kg per (every) 24 hr urokinase for 72 hr postoperatively. Clinical symptoms, shock index (SI), systolic pulmonary artery pressure (sPAP), peripheral arterial partial pressure of oxygen (PaO2), and Miller index (MI) were assessed before and after treatment. RESULTS: The patients included 16 men and 10 women (49.9 ± 18.8 years old; time to onset of 50.2 ± 28.5 hr). After thrombolysis, dyspnea and cough were relieved to varying degrees; chest pain, hemoptysis, and syncope disappeared. Importantly, a clinical success rate of 100% was achieved. All objective indices were improved: SI decreased from 1.74 ± 0.38 before operation to 0.71 ± 0.09 postoperatively (P = 0.00); PaO2 increased from 52.78 ± 6.92 mm Hg to 85.98 ± 5.91 mm Hg (P = 0.00); sPAP was reduced from 65.19 ± 8.22 mm Hg to 34.42 ± 4.05 mm Hg (P = 0.00); MI dropped from 0.69 ± 0.09 to 0.33 ± 0.06 (P = 0.00). Mean total urokinase amounts were 1,298,000 IU for each patient. Postoperative complications included 2 cases of puncture-site hematoma (cured by pressure bandage) and 1 case of gastrointestinal hemorrhage (healed by conservative treatment without blood transfusion). CONCLUSIONS: SCDT may be considered a safe and efficacious treatment for AMPTE.


Assuntos
Cateterismo de Swan-Ganz , Fibrinolíticos/administração & dosagem , Embolia Pulmonar/terapia , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tipo Uroquinase/administração & dosagem , Doença Aguda , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/instrumentação , Cateteres de Demora , Angiografia por Tomografia Computadorizada , Feminino , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Flebografia/métodos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Estudos Retrospectivos , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Fatores de Tempo , Resultado do Tratamento , Ativador de Plasminogênio Tipo Uroquinase/efeitos adversos , Dispositivos de Acesso Vascular , Adulto Jovem
9.
Vasc Endovascular Surg ; 52(3): 195-201, 2018 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-29436310

RESUMO

PURPOSE: Catheter-directed thrombolysis (CDT) is a relatively new therapy for pulmonary embolism that achieves the superior clot resolution compared to systemic thrombolysis while avoiding the high bleeding risk intrinsically associated with that therapy. In order to examine the efficacy and safety of CDT, we conducted a retrospective cohort study of patients undergoing ultrasound-assisted CDT at our institution. METHODS: The charts of 30 consecutive patients who underwent CDT as a treatment of pulmonary embolism at our institution were reviewed. Risk factors for bleeding during thrombolysis were noted. Indicators of the right heart strain on computed tomography and echocardiogram, as well as the degree of pulmonary vascular obstruction, were recorded before and after CDT. Thirty-day mortality and occurrence of bleeding events were recorded. RESULTS: Nine (30%) patients had 3 or more minor contraindications to thrombolysis and 14 (47%) had major surgery in the month prior to CDT. Right ventricular systolic pressure and vascular obstruction decreased significantly after CDT. There was a significant decrease in the proportion of patients with right ventricular dilation or hypokinesis. Decrease in pulmonary vascular obstruction was associated with nadir of fibrinogen level. No patients experienced major or moderate bleeding attributed to CDT. CONCLUSION: Catheter-directed thrombolysis is an effective therapy in rapidly alleviating the right heart strain that is associated with increased mortality and long-term morbidity in patients with pulmonary embolism with minimal bleeding risk. Catheter-directed thrombolysis is a safe alternative to systemic thrombolysis in patients with risk factors for bleeding such as prior surgery. Future studies should examine the safety of CDT in patients with contraindications to systemic thrombolysis.


Assuntos
Cateterismo de Swan-Ganz , Fibrinolíticos/administração & dosagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/métodos , Ativador de Plasminogênio Tecidual/administração & dosagem , Ultrassonografia de Intervenção , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/mortalidade , Angiografia por Tomografia Computadorizada , Ecocardiografia Doppler , Feminino , Fibrinolíticos/efeitos adversos , Florida , Hemorragia/induzido quimicamente , Humanos , Hipertrofia Ventricular Direita/etiologia , Hipertrofia Ventricular Direita/fisiopatologia , Infusões Intra-Arteriais , Masculino , Pessoa de Meia-Idade , Embolia Pulmonar/complicações , Embolia Pulmonar/mortalidade , Embolia Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/mortalidade , Fatores de Tempo , Ativador de Plasminogênio Tecidual/efeitos adversos , Resultado do Tratamento , Disfunção Ventricular Direita/etiologia , Disfunção Ventricular Direita/fisiopatologia , Função Ventricular Direita , Pressão Ventricular , Adulto Jovem
11.
Catheter Cardiovasc Interv ; 91(5): 911-919, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29357196

RESUMO

BACKGROUND: Transcatheter, bilateral branch pulmonary artery (PA) valve implantation is a novel treatment for patients with severe pulmonary insufficiency and oversized right ventricle (RV) outflow tract. There is scarce data on efficacy and safety of this approach. METHODS: This was a retrospective study of 8 patients with repaired tetralogy of fallot (TOF) who underwent bilateral branch PA valve implantation. Demographics, echocardiography, cardiac catheterization, and axial imaging data were reviewed. Variables were compared by a paired sample t-test. RESULTS: All patients were adult sized (weight 43-99 kg) with oversized RV outflow tract not suitable for conventional transcatheter pulmonary valve implantation. Staged bare metal PA stenting followed by valve implantation (interval 3-5 months) was technically successful in 7 patients with one stent embolization. In another patient, proximal stent migration prevented placement of bilateral pulmonary valve stents. There were a total of 14 valved branch PA stents placed (Melody valve n = 9, Sapien XT n = 2, Sapien 3 n = 3). In the 7 patients undergoing successful branch pulmonary valve placement, at median follow up of 10 months (range 3 months to 6 years), 13 (93%) valves had none/trivial insufficiency on echocardiography. Prevalve and postvalve implantation cardiac magnetic resonance imaging in five patients showed significant reduction of indexed RV end-diastolic volume (152 ± 27 to 105 ± 15 mL/m2 , P < .001). CONCLUSIONS: Transcatheter, bilateral branch PA valve implantation was technically feasible with satisfactory efficacy and safety in patients with repaired TOF, severe pulmonary insufficiency, and oversized RV outflow tracts. Elimination of pulmonary insufficiency with this method resulted in reduced RV end-diastolic volume. This approach can be offered as an alternative to surgery, particularly in patients considered high risk for standard surgical placement and who are not candidates for the newer self-expanding valve prosthesis for placement in RV outflow tracts larger than 30 mm diameter.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Cateterismo de Swan-Ganz/instrumentação , Implante de Prótese de Valva Cardíaca/instrumentação , Próteses Valvulares Cardíacas , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Stents , Tetralogia de Fallot/cirurgia , Adolescente , Adulto , Idoso , Angiografia , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/métodos , Ecocardiografia , Feminino , Implante de Prótese de Valva Cardíaca/efeitos adversos , Implante de Prótese de Valva Cardíaca/métodos , Hemodinâmica , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/etiologia , Insuficiência da Valva Pulmonar/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Índice de Gravidade de Doença , Tetralogia de Fallot/fisiopatologia , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
12.
Ann Am Thorac Soc ; 15(2): 134-144, 2018 02.
Artigo em Inglês | MEDLINE | ID: mdl-29073366

RESUMO

Intermediate-risk pulmonary embolism is common and carries a risk of progression to hemodynamic collapse and death. Catheter-directed thrombolysis is an increasingly used treatment option, based largely on the assumptions that it is more efficacious than anticoagulation alone and safer than systemic thrombolysis. In this review, we critically analyze the published data regarding catheter-directed thrombolysis for the treatment of intermediate-risk pulmonary embolism. Catheter-directed thrombolysis reduces right heart strain and lowers pulmonary artery pressures more quickly than anticoagulation alone. The mortality for patients with intermediate-risk pulmonary embolism treated with catheter-directed thrombolysis is low, between 0% and 4%. However, similarly low mortality is seen with anticoagulation alone. Catheter-directed thrombolysis appears to be safer than systemic thrombolysis, and procedural complications are uncommon. Bleeding risk appears to be slightly higher than with anticoagulation alone. Randomized, controlled trials are needed to compare the efficacy and safety of catheter-directed thrombolysis versus anticoagulation for intermediate-risk pulmonary embolism. There is no evidence that catheter-directed thrombolysis decreases the incidence of chronic thromboembolic pulmonary hypertension. There is no evidence from clinical studies that ultrasound-assisted thrombolysis is more effective or safer than standard catheter-directed thrombolysis.


Assuntos
Cateterismo de Swan-Ganz , Embolia Pulmonar , Terapia Trombolítica , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/métodos , Humanos , Prognóstico , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Medição de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/métodos , Resultado do Tratamento
13.
Catheter Cardiovasc Interv ; 91(5): 920-926, 2018 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-29280541

RESUMO

BACKGROUND: Transcatheter pulmonary valve implantation (TPVI) has revolutionized the care of patients with congenital disorders of the right ventricular outflow tract (RVOT) and is increasingly being used in patients with native outflow tracts. This is the first study to specifically report the occurrence of ventricular arrhythmias in the immediate post-TPVI period. METHODS AND RESULTS: Medical records of all adult and pediatric patients who underwent TPVI at our institution between May 1, 2011 and March 1, 2016, were reviewed for the presence of clinically significant ventricular arrhythmias occurring within 30 days of TPVI. We defined a clinically significant arrhythmia as any ventricular arrhythmia that led to hemodynamic instability, resulted in a change of dose or addition of a new anti-arrhythmic medication, caused a delay in discharge, or was the primary reason for readmission. Seventy-five patients, with a median age of 19 years (range 4-65 years), underwent TPVI. In total, 12 (16%) patients had a clinically significant ventricular arrhythmia within 30 days following TPVI. Patients with native outflow tracts were at higher risk of post-TPVI arrhythmias than non-native outflow tract (29% vs. 9%, P = 0.02, adjusted OR 4.8, 95%CI 1.2-20.2). There were no cases of hemodynamic compromise or sudden cardiac death. The arrhythmias were well controlled with beta-blocker therapy. CONCLUSION: In this single center study, ventricular arrhythmias were common following TPVI, particularly in native outflow tract patients. However, the arrhythmias were generally benign and responded well to medical therapy when indicated. Long term therapy was often not needed.


Assuntos
Arritmias Cardíacas/etiologia , Cateterismo de Swan-Ganz/efeitos adversos , Frequência Cardíaca , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Pulmonar/cirurgia , Adolescente , Antagonistas Adrenérgicos beta/uso terapêutico , Adulto , Idoso , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/diagnóstico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/fisiopatologia , Cateterismo de Swan-Ganz/métodos , Criança , Pré-Escolar , Feminino , Frequência Cardíaca/efeitos dos fármacos , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/fisiopatologia , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
14.
J Intensive Care Med ; 33(5): 322-324, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-28946777

RESUMO

A 60-year-old female patient underwent emergency cadaveric liver transplantation. During the insertion of the pulmonary artery catheter (PAC) through the left innominate vein, advancement of the catheter was not successful and a knot occurred. An interventional radiologist performed antegrade rigid wire insertion into the PAC and succeeded in loosening the knot in the vessel. We report the successful removal of a knot through intervention without additional invasive procedures in a hemodynamically unstable patient with a coagulopathy.


Assuntos
Cateteres Cardíacos/efeitos adversos , Cateterismo de Swan-Ganz/efeitos adversos , Remoção de Dispositivo/métodos , Cuidados Intraoperatórios/efeitos adversos , Transplante de Fígado/métodos , Cateterismo de Swan-Ganz/métodos , Feminino , Humanos , Cuidados Intraoperatórios/métodos , Pessoa de Meia-Idade , Artéria Pulmonar/cirurgia
15.
Tech Vasc Interv Radiol ; 20(3): 193-196, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29029714

RESUMO

Treatment of acute submassive pulmonary embolism (PE) with thrombolytic therapy remains an area of controversy. For patients who fail or who have contraindications to systemic thrombolysis, catheter-directed therapy (CDT) may be offered depending on the patient's condition and the available institutional resources to perform CDT. Although various CDT techniques and protocols exist, the most studied method is low-dose catheter-directed thrombolytic infusion without mechanical thrombectomy. This article reviews current protocols and data on the use of CDT for acute submassive pulmonary embolism.


Assuntos
Cateterismo de Swan-Ganz/instrumentação , Cateteres , Protocolos Clínicos , Medicina Baseada em Evidências , Fibrinolíticos/administração & dosagem , Embolia Pulmonar/tratamento farmacológico , Terapia Trombolítica/instrumentação , Doença Aguda , Cateterismo de Swan-Ganz/efeitos adversos , Desenho de Equipamento , Fibrinolíticos/efeitos adversos , Humanos , Infusões Intra-Arteriais , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/fisiopatologia , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Resultado do Tratamento
16.
Tech Vasc Interv Radiol ; 20(3): 224-226, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29029718

RESUMO

This article will focus on 3 avenues for future research: (1) addressing the lack of short- and long-term clinical outcome research on catheter-directed therapy; (2) determining the safety and efficacy of novel thrombus removal devices; and (3) translating our knowledge of the pathobiology and pathophysiology of pulmonary embolism into novel diagnostic and therapeutic strategies.


Assuntos
Cateterismo de Swan-Ganz/tendências , Cateteres/tendências , Ensaios Clínicos como Assunto/métodos , Fibrinolíticos/administração & dosagem , Lacunas da Prática Profissional/tendências , Embolia Pulmonar/terapia , Projetos de Pesquisa/tendências , Terapia Trombolítica/tendências , Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/instrumentação , Difusão de Inovações , Desenho de Equipamento , Fibrinolíticos/efeitos adversos , Previsões , Humanos , Infusões Intra-Arteriais , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/fisiopatologia , Fatores de Risco , Terapia Trombolítica/efeitos adversos , Terapia Trombolítica/instrumentação , Resultado do Tratamento
17.
Life Sci ; 188: 17-25, 2017 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-28864224

RESUMO

AIMS: Catheter-directed therapy (CDT) is included in the guidelines for diagnosing and treating massive pulmonary embolism. However, few studies have evaluated the efficacy of CDT as a treatment for submassive pulmonary embolism (SPE). Therefore, we used evidence-based medicine to evaluate the effectiveness and safety of CDT in treating SPE. METHODS: Search terms describing CDT in SPE and patients with intermediate pulmonary embolism were entered into the PubMed, Embase and Cochrane Library databases to identify relevant articles without language restrictions published between January 1990 and December 2016. A quality assessment and data extraction were performed by two investigators. The clinical efficacy of and major complications associated with treatment were analysed using a fixed effects model. KEY FINDINGS: A total of 552 patients in 16 studies were included in this meta-analysis. The clinical success rate in CDT was approximately 100% (95% confidence interval (CI): 99%, 100%), the primary bleeding rate was 0.02% (95% CI: 0%, 0.05%), and mortality during hospitalization was approximately 0% (95% CI: 0%, 0.01%). The mean decrease in pulmonary artery systolic pressure after treatment was -14.9% (95% CI: -19.25%, -10.55%), and the mean post-treatment change in the ratio of the right to the left ventricle (RV/LV) was -0.35% (95% CI: -0.48%, -0.22%). SIGNIFICANCE: CDT is effective and safe as a treatment for SPE and could be a first-line treatment for SPE under specific conditions.


Assuntos
Cateterismo de Swan-Ganz , Embolia Pulmonar/terapia , Pressão Sanguínea/fisiologia , Cateterismo de Swan-Ganz/efeitos adversos , Humanos , Embolia Pulmonar/fisiopatologia , Resultado do Tratamento
18.
Ann Thorac Surg ; 104(3): e225-e226, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28838512

RESUMO

Swan-Ganz catheter entrapment in the heart, vena cava, or pulmonary artery is rare but may lead to life-threatening events. We report a case of severe tricuspid regurgitation resulting from papillary muscle rupture during percutaneous removal of a Swan-Ganz catheter (SCG) caught by a surgical suture. We performed urgent tricuspid valve repair by suturing the ruptured papillary muscle. This report highlights preventive measures to avoid suture-related entrapment and raises a word of caution regarding percutaneous removal of accidentally entrapped SCGs.


Assuntos
Cateterismo de Swan-Ganz/efeitos adversos , Cateterismo de Swan-Ganz/instrumentação , Remoção de Dispositivo , Suturas/efeitos adversos , Insuficiência da Valva Tricúspide/etiologia , Insuficiência da Valva Tricúspide/cirurgia , Idoso , Feminino , Humanos , Músculos Papilares/cirurgia , Insuficiência da Valva Tricúspide/diagnóstico
20.
Cardiovasc Pathol ; 31: 17-19, 2017.
Artigo em Inglês | MEDLINE | ID: mdl-28806628

RESUMO

BACKGROUND: Introduced in 1970, the Swan-Ganz catheter (SGC) soon became widely used because of its unique usefulness in managing intensive care patients. Unfortunately, SGC usage was complicated by pulmonary artery rupture (PAR) with a 50% mortality rate that led to a near banning of the SCG in the late 1980s. Increasing knowledge and decreasing incidence of SGC-related PARs (SGPARs) led to the current feeling that the present SGPAR incidence is now low enough to tolerate given the lives saved by SGC usage. However, an important unknown is that, to our knowledge, pathologists have never published a comprehensive microscopic description of a SGPAR. CASE REPORT: A 73-year-old woman with moderate pulmonary hypertension died from a SGPAR soon after single SGC measurements of right ventricular and pulmonary capillary wedge pressures. By using what we thought to be an appropriate method of dissection, we did a complete microscopic step section study of the 1.6 cm SGPAR revealing 12 relatively uniform longitudinal tears (one perforating) consistent with an overinflated SGC balloon or a weakened arterial wall. LITERATURE REVIEW: A MEDLINE search of 38 consecutive SGPARs from 2014 to 1980 found 52 cases in 38 papers. Analysis revealed that all 46 SGPARs suitable for study came from large institutions, and confirmed that elderly women were more likely to have SGPARs than elderly men. CONCLUSIONS: More and better data are needed before fully informed decisions can be made regarding future SGC usage.


Assuntos
Cateterismo de Swan-Ganz/efeitos adversos , Artéria Pulmonar/patologia , Idoso , Feminino , Humanos , Hipertensão Pulmonar/cirurgia , Ruptura Espontânea
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA