Story of a Little Right Ventricular Pseudoaneurysm
Author(s)
Melek Zekiye Ulucam*
ABSTRACT
Cardiac trauma caused by Swann-Ganz catheter may very rarely cause cardiac perforation, tamponade and right ventricular pseudoaneurysm. In contrast to left ventricular equivalants, pseudoaneurysms of the RV have a weak tendency to rupture. Its impact on patient outcomes should be assesed very carefully depending on its size, filling rate/capacity. It is possible not to operate the patient and follow progression of RV pseudoaneurysm by clinical and echocardiographic findings. This case is a good sample for it and describes the lifespan of a small RV pseudoaneurysm. It is not only the unique right ventricle pseudoaneurysm due to cardiac trauma caused by Swann Ganz catheter, but medically treated case without surgery and recovered completely.
Cardiac trauma caused by Swann-Ganz catheter may very rarely cause cardiac perforation, tamponade and right ventricular pseudoaneurysm. In contrast to left ventricular equivalants, pseudoaneurysms of the RV have a weak tendency to rupture. Its impact on patient outcomes should be assesed very carefully depending on its size, filling rate/capacity. It is possible not to operate the patient and follow progression of RV pseudoaneurysm by clinical and echocardiographic findings. This case is a good sample for it and describes the lifespan of a small RV pseudoaneurysm. It is not only the unique right ventricle pseudoaneurysm due to cardiac trauma caused by Swann Ganz catheter, but medically treated case without surgery and recovered completely.
Cite this paper
M. Ulucam, "Story of a Little Right Ventricular Pseudoaneurysm," Open Journal of Medical Imaging, Vol. 2 No. 4, 2012, pp. 162-166. doi: 10.4236/ojmi.2012.24026.
M. Ulucam, "Story of a Little Right Ventricular Pseudoaneurysm," Open Journal of Medical Imaging, Vol. 2 No. 4, 2012, pp. 162-166. doi: 10.4236/ojmi.2012.24026.
References
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Laks, et al., “Catheter-Induced Pulmonary Artery Perforation, Mechanisms, Management and Modifications,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 82, No. 1, 1981, pp. 5-12. [23] P. F. Cohn, E. Braunwald. “Traumatic Heart Disease,” In: E. Braunwald, Ed., Heart Disease: A Textbook of Cardiovascular Medicine,” W.B. Saunders, Philadelphia, 1992, pp. 1517-1527. [24] Y. G. Cherng, Y. J. Cheng, T. G. Chen, C. M. Wang and C. C. Liu, “Cardiac Tamponade in an Infant—A Rare Complication of Central Venous Catheterization,” Anaesthesia, Vol. 49, No. 12, 1994, pp. 1052-1054. doi:10.1111/j.1365-2044.1994.tb04354.x [25] G. Nasim, G. Cooper and A. K. Ah-See, “Cardiac Tamponade Due to Central Venous Catheterization,” Journal of the Royal College of Surgeons of Edinburgh, Vol. 37, No. 5, 1992, pp. 337-339. [26] P. E. Collier, J. J. Ryan and D. L. Diamond, “Cardiac Tamponade from Central Venous Catheters. Report of a Case and Review of the English Literature,” Angiology, Vol. 35, No. 9, 1998, pp. 595-600. doi:10.1177/000331978403500909 [27] J. S. Rutherford, A. F. Merry and C. J. Occleshaw, “Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac Surgical Unit,” Anaesthesia and Intensive Care, Vol. 22, 1994, pp. 267-271. [28] P. Harrity, A. Patel, J. Bianco and R. Subramanian, “Improved Diagnosis and Characterization of Postinfarction Left Ventricular Pseudoaneurysm by Cardiac Magnetic Resonance Imaging,” Clinical Cardiology, Vol. 14, No. 7, 1991, pp. 603-606. doi:10.1002/clc.4960140713
[1] S. A. Booth, B. Norton and D. A. Mulvey, “Central Venous Catheterization and Fatal Cardiac Tamponade,” British Journal of Anaesthesia, Vol. 87, No. 2, 2001, pp. 298-302. doi:10.1093/bja/87.2.298 [2] X. Shen, M. J. Holmberg, J. Sype, C. Hunter, A. N. Mooss and S. M. Mohiuddin, “Real-Time Three-Dimensional Echocardiography in Diagnosis of Right Ventricular Pseudoaneurysm after Pacemaker Implantation,” Echocardiography, Vol. 23, No. 3, 2006, pp. 240-243. doi:10.1111/j.1540-8175.2006.00156.x [3] C. Rodrigues, A. de Vylder, F. Wellens, J. Bartunek and B. De Bruyne, “Right Ventricular Pseudoaneurysm as a Complication of Endomyocardial Biopsy after Heart Transplantation,” Chest, Vol. 107, No. 2, 1995, pp. 566567. doi:10.1378/chest.107.2.566 [4] F. Saraiva, V. Matos, L. Gon?alves, M. Antunes and L. A. Providência, “Complications of Endomyocardial Biopsy in Heart Transplant Patients: A Retrospective Study of 2117 Consecutive Procedures,” Transplant Proceedings, Vol. 43, No. 5, 2011, pp. 1908-1912. doi:10.1016/j.transproceed.2011.03.010 [5] J. Trzebicki, W. Lisik, B. Blaszczyk, M. Pacholczyk, M. Fudalej, A. Chmura, et al., “Unexpected Fatal Right Ventricular Rupture during Liver Transplantation: Case Report,” Annals of Transplantation, Vol. 16, No. 1, 2011, pp. 70-74. [6] K. Chatterjee, “The Swan-Ganz Catheters: Past, Present and Future. A Viewpoint,” Circulation, Vol. 119, No. 1, 2009, pp. 147-152. doi:10.1161/CIRCULATIONAHA.108.811141 [7] J. Moen, W. Hansen, K. Chandrasekaran and J. B. Seward, “Traumatic Aneurysm and Pseudoaneurysm of the Right Ventricle: A Diagnosis by Echocardiography,” Journal of the American Society of Echocardiography, Vol. 15, No. 9, 2002, pp. 1025-1026. doi:10.1067/mje.2002.122079 [8] M. Karimi, A. Farouk, J. Stork and H. A. Hennein, “Right Ventricular Aneurysm Following Modified NorwoodSano Operation for Hypoplastic Left Heart Syndrome,” Interactive CardioVasc Thoracic Surgery, Vol. 7, No. 4, 2008, pp. 664-666. doi:10.1510/icvts.2007.171777 [9] C. Arslan, B. Kayhan, T. Turan and L. Kaplan, “Right Ventricular Pseudoaneurysm after Myocardial Infarction,” Turkish Journal of Thoracic and Cardiovascular Surgery, Vol. 12, 2004, pp. 128-129. [10] E. Eren, N. Bozbuga, M. E. Toker, C. Keles, M. B. Rabus, O. Yildirim, et al., “Surgical Treatment of Post-Infarction Left Ventricular Pseudoaneurysm: A Two-Decade Experience,” Texas Heart Institute Journal, Vol. 34, No. 1, 2007, pp. 47-51. [11] D. Karakaya, S. Baris and A. Tur, “Pulmonary Artery Catheter-Induced Right Ventricular Perforation during Coronary Artery Bypass Surgery,” British Journal of Anaesthesia, Vol. 82, No. 6, 1999, p. 953. doi:10.1093/bja/82.6.953 [12] M. A. Lyew, D. R. Bacon and M. S. Nesarajah, “Right Ventricular Perforation by a Pulmonary Artery Catheter during Coronary Artery Bypass Surgery,” Anesthesia & Analgesia, Vol. 82, No. 5, 1996, pp. 1089-1090. [13] M. Auxiliadora-Martins, E. Apinagés Dos Santos, D. Adans Wenzinger, G. C. Alkmim-Teixeira, G. C. de M Neto, A. K. Sankarankutty, et al., “Perforation of the Right Ventricle induced by Pulmonary Artery Catheter at Induction of Anesthesia for the Surgery for Liver Transplantation: A Case Report and Reviewed of Literature,” Case Reports in Medicine, Vol. 2009, 2009, p. 650982. doi:10.1155/2009/650982 [14] K. C. Chuang, A. K. Lan, H. N. Luk, C. S. Wang, C. J. Huang, K. W. Cheng, et al., “Perforation of the Right Ventricle by a Pulmonary Artery Catheter that Continues to Measure Cardiac Output and Mixed Venous Saturation,” Journal of Clinical Anesthesia, Vol. 17, No. 2, 2005, pp. 124-127. doi:10.1016/j.jclinane.2004.05.008 [15] J. A. Cohen, R. H. Blackshear, N. Gravenstein and J. Woeste, “Increased Pulmonary Artery Perforating Potential of Pulmonary Artery Catheters during Hypothermia,” Journal of Cardiothoracic and Vascular Anesthesia, Vol. 5, No. 3, 1991, pp. 234-236. doi:10.1016/1053-0770(91)90280-7 [16] C. M. Domaingue and A. L. White, “Right ventricular Perforation in a Patient with a Pulmonary Artery Catheter,” Journal of Cardiothoracic Anesthesia, Vol. 2, No. 2, 1988, pp. 223-224. doi:10.1016/0888-6296(88)90276-1 [17] S. P. Maschke and H. J. Rogove, “Cardiac Tamponade Associated with a Multilumen Central Venous Catheter,” Critical Care Medicine, Vol. 12, No. 7, 1984, pp. 611613. doi:10.1097/00003246-198407000-00017 [18] H. J. Swan, W. Ganz, J. Forrester, H. Marcus, G. Diamond and D. Chonette, “Catheterisation of Heart in Man with Use of a Flow-Directed Balloon Tipped Catheter,” The New England Journal of Medicine, Vol. 283, No. 9, 1970, pp. 447-451. doi:10.1056/NEJM197008272830902 [19] K. B. Shah, T. L. Rao, S. Laughlin and A. A. El-Etr, “A Review of Pulmonary Artery Catheterization in 6,245 Patients,” Anesthesiology, Vol. 61, No. 3, 1984, pp. 271-275. doi:10.1097/00000542-198409000-00007 [20] N. B. Bagul, N. J. Menon, R. Pathak, A. Platts and G. Hamilton, “Knot in the Cava—An Unusual Complication of Swan-Ganz Catheter,” European Journal of Vascular and Endovascular Surgery, Vol. 29, No. 6, 2005, pp. 651-653. doi:10.1016/j.ejvs.2005.02.017 [21] T. B. Bossert, J. F. Gummert, H. B. Bittner, M. Barten, T. Walther, V. Falk, et al., “Swan Ganz Catheter Induced Severe Complicaton in Cardiac Surgery: Right Ventricular Perforation, Knotting, and Rupture of a Pulmonary Artery,” Journal of Cardiac Surgery, Vol. 21, No. 3, 2006, pp. 292-295. doi:10.1111/j.1540-8191.2006.00235.x [22] P. G. Barash, D. Nardi, G. Hammond, G. Walker-Smith, D. Capuano, H. Laks, et al., “Catheter-Induced Pulmonary Artery Perforation, Mechanisms, Management and Modifications,” The Journal of Thoracic and Cardiovascular Surgery, Vol. 82, No. 1, 1981, pp. 5-12. [23] P. F. Cohn, E. Braunwald. “Traumatic Heart Disease,” In: E. Braunwald, Ed., Heart Disease: A Textbook of Cardiovascular Medicine,” W.B. Saunders, Philadelphia, 1992, pp. 1517-1527. [24] Y. G. Cherng, Y. J. Cheng, T. G. Chen, C. M. Wang and C. C. Liu, “Cardiac Tamponade in an Infant—A Rare Complication of Central Venous Catheterization,” Anaesthesia, Vol. 49, No. 12, 1994, pp. 1052-1054. doi:10.1111/j.1365-2044.1994.tb04354.x [25] G. Nasim, G. Cooper and A. K. Ah-See, “Cardiac Tamponade Due to Central Venous Catheterization,” Journal of the Royal College of Surgeons of Edinburgh, Vol. 37, No. 5, 1992, pp. 337-339. [26] P. E. Collier, J. J. Ryan and D. L. Diamond, “Cardiac Tamponade from Central Venous Catheters. Report of a Case and Review of the English Literature,” Angiology, Vol. 35, No. 9, 1998, pp. 595-600. doi:10.1177/000331978403500909 [27] J. S. Rutherford, A. F. Merry and C. J. Occleshaw, “Depth of Central Venous Catheterization: An Audit of Practice in a Cardiac Surgical Unit,” Anaesthesia and Intensive Care, Vol. 22, 1994, pp. 267-271. [28] P. Harrity, A. Patel, J. Bianco and R. Subramanian, “Improved Diagnosis and Characterization of Postinfarction Left Ventricular Pseudoaneurysm by Cardiac Magnetic Resonance Imaging,” Clinical Cardiology, Vol. 14, No. 7, 1991, pp. 603-606. doi:10.1002/clc.4960140713