Right Ventricular Perforation with the Body of Swan-Ganz Catheter during Lung Transplantation by ECMO Support: A Case Report

Jahangirifard, Alireza; Hossein Ahmadi, Zargham; Khalili, Ali; Daneshvar Kakhaki, Abolghasem; Sheikhy, Kambiz

Right Ventricular Perforation with the Body of Swan-Ganz Catheter during Lung Transplantation by ECMO Support: A Case Report

Authors

Alireza Jahangirifard ¹

Zargham Hossein Ahmadi ¹

Ali Khalili ²

Abolghasem Daneshvar Kakhaki ¹

Kambiz Sheikhy ¹

¹ Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran.

² Tracheal Diseases Research Center, NRITLD, Shahid Beheshti University of Medical Sciences, Tehran, Iran

Abstract

A 46-year-old woman with a 12-year history of lymphangiomyomatosis (LAM) was admitted for lung transplantation in January 2017. We decided to apply veno-arterial extracorporeal membrane oxygenation (ECMO) to manage arrhythmia and hypotension during lung transplantation, since it was not controllable with inotropic drugs. After transplanting the right (first) lung and at the time of left pneumonectomy, the body of the Swan-Ganz catheter was suddenly observed to be protruding from the right ventricular (RV) wall. The catheter was found folded at part of its body and ran out 0.5 cm from the RV. The protruding part of the catheter was inserted before the perforated part of the cardiac muscle was repaired in order to control the bleeding. ECMO was used throughout the rest of the procedure and the patient was transferred to the intensive care unit (ICU) in good condition before being weaned from the ventilator after 16 hours. It seems that gentle manipulation, concurrent use of transesophageal echocardiography (TEE), insertion of the appropriate length of the catheter into the heart chambers, and a softer material in the structure of the catheters would be helpful to prevent these kinds of potentially fatal complications.

Keywords

Right ventricle

Perforation

Lung transplantation

Extracorporeal Membrane Oxygenation (ECMO)