[Perforation of the superior vena cava and hemothorax caused by insertion of a pulmonary artery catheter].Masui 2001; 50(7):783-5M
A 70-year-old woman with aortic regurgitation was scheduled for aortic valve replacement. After induction of anesthesia resistance was encountered when attempting to remove the guide wire with a sheath dilator prior to insertion of a pulmonary artery (PA) catheter through the right internal jugular vein. Ten hours after catheter insertion, chest X-ray examination in ICU showed poorly delineated right lung field, and hemothorax was suspected, as a large amount of fluid was also seen draining from the chest drain tube. Twenty two hours after catheter insertion, we opened her chest and found that the superior vena cava (SVC) had been perforated. After surgical closure of the hole on the SVC, the hemodynamics because stabilized and active bleeding was controlled. The patient was subsequently discharged from the hospital without any further complications. This perforation was thought to be caused by carelessness during insertion of the PA catheter. To prevent serious complications, such as perforation of the great vessels or heart by a catheter, the results of the present case suggest that careful attention is required during catheterization, especially when resistance is encountered.