Swan-Ganzカテーテルによる肺動脈損傷の1例

Abstract

An accidental rupture of the pulmonary artery is reported in a 72-year-old woman. On November 8, 1997, she was admitted for acute myocardial infarction. Marked ST segment elevation in Ⅰ, aVL, Ⅱ, aVF and V2 from V6 were evident by electrocardiogra- phy. Cardiac catheterization showed a normal coronary artery with left ventricular failure. During the procedure, the patient received an initial bolus injection of 10,000 IU of heparin. A size 7 Fr Swan-Ganz catheter was inserted without difficulty. Mean pulmonary artery wedge pressure was 14 mmHg. After catheterization, immediately after the balloon was inflated for a PAWP measurement at the bedside, the patient developed a cough followed by massive hemoptysis. The possibility of a pulmonary artery rupture was considered. Protamine was injected through the distal port of the pulmonary artery catheter. After 2 hours, the patient had no further hemoptysis. Pulmonary artery rupture due to the use of a Swan-Ganz catheter is rare, with an estimated 0.001 to 0.47% incidence rate. Because such a rupture is fatal in almost 50% of cases, it is important to prevent such complications during the use of Swan-Ganz catheters.