Successful retrieval of a knotted pulmonary artery catheter trapped in the tricuspid valve apparatus
A 64-year-old man with a 20-month history of exertional chest pain presented for elective myocardial revascularization. Past medical history included hypertension, type 2 diabetes mellitus, and hypercholesterolemia. The patient underwent coronary angiogram, which revealed extensive diffuse 3 vessel disease and very poor left ventricular function with an ejection fraction of about 25%. Trans-thoracic echo showed dilated left ventricle with severe left ventricular dysfunction. Recent MRI showed extensive regional wall motion abnormalities, but no late gadolinium enhancement despite wall thinning, suggestive of viable and hibernating myocardium. Preoperative vital signs, physical examination, electrocardiogram, chest X-ray results, and laboratory values were consistent with the patient's underlying conditions and revealed no acute changes in his condition.\nInvasive monitoring was inserted in the anesthetic room. This consisted of a brachial arterial line, a right internal jugular central venous catheter, and a sheath for a PAC. A PAC was passed into the pulmonary artery. Attempts to wedge the PAC were unsuccessful and when we tried to withdraw the PAC we found that it was tethered. A transesophageal echocardiography (TOE) confirmed that the PAC was tangled in the tricuspid valve apparatus []. TOE of the knotted PAC in the tricuspid valve apparatus.\nThe help of an interventional radiologist was sought. Under fluoroscopy the PAC was wired and using traction over the wire the knot was worked along to the end of the catheter and released. This allowed the PAC to be re-floated with a satisfactory pulmonary wedge pressure in the right pulmonary artery. The patient's postoperative course was entirely uneventful. He made good progress in the ward and was discharged home [Figure and ]. X-ray of the knotted PACs.