No abstract available.
Catheterization, Swan-Ganz* ; Oximetry* ; Pulmonary Artery*

BACKGROUND: The hemodynamic status of critically ill patients is poorly predicted from clinical examination and chest x-ray findings, so equipments such as pulmonary artery catheter are needed for monitoring of hemodynamics. The authors undertook this study to evaluate physician's accuracy in predicting hemodynamic profiles, rates of therapeutic change resulting from catheterization and to compare the outcomes with or without therapeutic changes. METHODS: Pulmonary artery catheters were inserted in 19 critically ill patients. The physicians accuracy of predicting the hemodynamic profile, the rate of therapeutic changes by monitoring actual hemodynamic profiles were calculated and compared to the outcome between the patients with and without therapeutic change, RESULTS: Hemodynamic profiles were correctly predicted in 63% of all cases. Hemodynamic data from pulmonary artery catheter made the therapeutic plan changed in 53% of all cases. The cardiac index and left ventricular stroke work index were improved and the mortality rate was lower in patients with therapeutic changes, but there were no significant statistical differences between the patients with and without therapeutic changes. Complications occurred in 6 cases but had no effect on patient' s outcome. CONCLUSIONS: Hemodynamic data from a pulmonary artery catheter could lead to a more accurate diagnosis and therapeutic changes.
Catheterization ; Catheterization, Swan-Ganz* ; Catheters ; Critical Illness* ; Diagnosis ; Hemodynamics* ; Humans ; Mortality ; Pulmonary Artery* ; Stroke ; Thorax

BACKGROUND: Mixed venous oxygen saturation (SO2) has been considered as an important parameter during therapy of critically ill patients. But pulmonary artery catheterization for monitoring of SO2 involves risks and sometimes may be contraindicated. The purpose of this study was to evaluate whether SO2 could be replaced by oxygen saturation of superior vena cava (SvcO2). METHODS: We inserted pulmonary artery catheter in 38 patients scheduled for undergoing mitral valve replacement. Blood samples for SO2 were drawn from PA ports of pulmonary artery catheter, blood samples for distal SvcO2 were drawn from CVP ports of pulmonary artery catheter and blood samples for proximal SvcO2 were drawn from distal ports of sheat introducer. RESULTS: There was no significant difference between SO2 and SvcO2 (79.6% and 79.9%, 78.0%), and also no significant difference between distal and proximal SvcO2 (79.9%, 78.0%). Correlation of SO2 and SvcO2 was good (r=0.69: PA and SVCD, r=0.62: PA and SVCP). CONCLUSION: We conclude that mixed venous oxygen saturation might be replaced by oxygen saturation of superior vena cava during mitral valve replacement.
Catheterization, Swan-Ganz ; Catheters ; Critical Illness ; Humans ; Mitral Valve* ; Oxygen* ; Pulmonary Artery* ; Vena Cava, Superior*

AIMTo introduce a new device and catheter to be determining cardiac output through cor sinistrum with thermodilution.

METHODSOwn control was introduced in eight dogs. A pulmonary thermodilution catheter was used through the cor dextrum of the dogs; The new-design catheter was used through artery, and there were two situs to fix:its ahead in left atrium and the ahead near to aortic root. Determine cardiac output (CO) under four circumstances: controlled respiration, apnoea, in controlled hypotension, after controlled hypotension.

RESULTSThere was no significant difference among the parameters (CO and cardiac index) of all circumstances. The CO determined by the pulmonary thermodilution catheter and those by the new-design catheter in two situs were positive correlation, and the gamma were 0.986, 0.989; likewise, the cardiac index (CI) was positive correlation, and the gamma were 0.983, 0.985. The CO and CI by the new-design catheter between two situs were positive, and the gamma were 0.992, 0.988.

CONCLUSIONThe parameters by the new-design catheter and those by the pulmonary thermodilution catheter were concordant. In comparison with the pulmonary thermodilution catheter, the new-design catheter had simple device and could be easily operated.

Pulmonary artery (PA) rupture caused by a PA Swan-Ganz catheter is a rare complication but remains fatal in almost 50% of cases. False aneurysm of the PA is a rare presentation of PA rupture and should be considered as a possible diagnosis in a patient with a new lung mass after PA catheterization. We present a case of sudden-onset pulmonary alveolar hemorrhage during cardiovascular surgery due to a traumatic PA false aneurysm. The Swan-Ganz catheter might have been displaced by the thoracic aortic aneurysm with displacement of the catheter causing the false aneurysm and bleeding.
Aneurysm, False* ; Aortic Aneurysm, Thoracic* ; Catheterization ; Catheterization, Swan-Ganz* ; Catheters ; Diagnosis ; Hemorrhage* ; Humans ; Lung ; Pulmonary Artery* ; Rupture

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.
Carcinoma, Hepatocellular ; Catheterization ; Catheterization, Swan-Ganz ; Catheters* ; Echocardiography, Transesophageal ; Fluoroscopy ; Humans ; Jugular Veins* ; Liver Transplantation ; Pulmonary Artery*

Case 1: A 30-year-old woman was scheduled for mitral valvuloplasty. A pulmonary artery (PA) catheter (Swan-Ganz CCOmbo model: 744HF75, Edwards(r), USA) was inserted via an introducer (8.5 Fr) placed in the right external jugular vein. The tip of the catheter could not be passed from the external jugular vein to the subclavian vein. When we attempted to advance the PA catheter again 30 minutes later, it could not be advanced or withdrawn. The PA catheter was removed with an introducer. The tip of the introducer had curled up into the intralummial space and the PA catheter had impacted in the narrowed lumen. Case 2: A 48-year-old woman was scheduled for tricuspid annuloplasty. A PA catheter was inserted via an introducer placed in the right internal jugular vein without problem. After opening the right atrium and withdrawing the PA catheter, a vinyl strip was found to have torn away from the distal part of the PA catheter.
Adult ; Catheterization, Swan-Ganz* ; Catheters ; Female ; Heart Atria ; Humans ; Jugular Veins ; Middle Aged ; Pulmonary Artery* ; Subclavian Vein

We report an extremely rare case of right ventricle perforation by a Swan-Ganz catheter during open heart surgery. Even when pulmonary artery catheters are inserted with the utmost care, serious complications such as hematoma formation, pneumothorax, hemothorax, perforation of the cardiac chambers, and rupture of the pulmonary artery may occur. We present a case of primary closure of a right ventricle perforation discovered during coronary artery bypass graft surgery. In this case, the Swan-Ganz catheter was found penetrating the anterior wall of the right ventricle during the surgery. The location of the Swan-Ganz catheter, the stiffness of the catheter caused by hypothermia, and excessive surgical manipulation were supposed to be the etiologies. Therefore, the location of the Swan-Ganz catheter and increased stiffness from hypothermia should be taken into consideration during heart surgery.
Catheterization, Swan-Ganz* ; Catheters ; Coronary Artery Bypass ; Heart Ventricles* ; Hematoma ; Hemothorax ; Humans ; Hypothermia ; Pneumothorax ; Pulmonary Artery ; Rupture ; Thoracic Surgery ; Transplants

BACKGROUND: In the management of liver transplantation, massive blood loss, interruption of venous retum to the heart, sudden infusion of acidic, cold and hyperkalemic blood from the graft, and uses of inotropic and vasoactive agents make cardiac output (CO) change unpredictably. We tried to find convenient method to estimate the change of CO by mixed venous oxygen saturation (SvO2) which can be monitored by pulmonary artery catheterization with fiberoptic oximeter using a spectrophotometer, By adapting the equation of oxygen transport and oxygen consumption(VO2), the equation CO=V/O2(Hbx0.134)x1/(SaO2-SvO2) can be obtained. If we assume the VO2 and hemoglobin concentration is constant and hypoxemia is excluded, CO might be proportional to I/(100-Sv O2). METHOD: For the management of orthotopic liver transplantations in 5 mongrel dogs, we continuously monitored Sv O2 with fiberoptic pulmonary catheter and intermittently measured the CO by thermodilution method according to operative phases. The Pearsons correlation coefficients between CO and mean arterial pressure, CO and S vO. and CO and 1/(100 SvO2) were measured in each dog. RESULT: The correlation coefficients between CO and 1/(100 SvO2) are raging from 0.74 to 0.98 with a corrected mean of 0.847 and significant in all dogs (p<0.05), and the correlation coefficients between CO and SvO2 are ranging from 0.67 to 0.96 with a corrected means of 0.786 and significant in 4 of 5 dogs. CONCLUSIONS: For the management of liver transplantation, the continuous monitoring of mixed venous oxygen saturation by a fiberoptic pulmonary catheter is helpful to detect changes of cardiac output.
Animals ; Anoxia ; Arterial Pressure ; Cardiac Output* ; Catheterization, Swan-Ganz ; Catheters ; Dogs* ; Heart ; Liver Transplantation* ; Liver* ; Oxygen* ; Rage ; Thermodilution ; Transplants

BACKGROUND: Mixed venous oxygen saturation (SO2) monitoring turned out to be invaluable in following up systemic cardiovascular status. But balloon-tipped flow-directed thermodilution catheter (Swan-Ganz catheter) insertion carries additional inherent risks other than those of central venous catheterization, and it costs much more expense than simple venous catheter. There has been a lot of papers which argue that central venous catheterization may substitute for the Swan-Ganz catheterization. In addition, it may be very difficult or impossible to insert the Swan-Ganz catheter in pediatric patients. This study was performed to determine whether Swan-Ganz catheterization might be replaced by the central venous catheterization in regards to SO2. METHODS: In 17 pediatric open heart surgery (OHS) patients, from the central venous catheter, the tip of which had been located in the center of right atrium (RA) and pulmonary artery, blood samples were drawn for gas analysis simultaneously, which was done immediately after emergence from cardiopulmonary bypass. RESULTS: There were no significant differences between RA blood and mixed venous blood gas analyses except oxygen saturation. The oxygen saturations of both were linearly correlated with each other. The relation was SO2=17 0.8 SRAO2 (R=0.77, p<0.05) CONCLUSIONS: It may be concluded that RA blood may be used for blood gas analysis in place of mixed venous blood immediately after pediatric open heart surgery.
Blood Gas Analysis ; Cardiopulmonary Bypass* ; Catheterization, Central Venous ; Catheterization, Swan-Ganz ; Catheters ; Central Venous Catheters ; Heart Atria ; Heart* ; Humans ; Oxygen* ; Pulmonary Artery ; Thermodilution ; Thoracic Surgery*