The Entrapped Pulmonary Artery Catheter

Where Should We Leave the Wild “Raa Raa” During Cardiopulmonary Bypass?

“…Although manipulating the PAC by small, intermittent advancements, withdrawals, and twisting motions succeeded in removing the PAC intact through the introducer in this case, [4] repeated manipulations of the PAC might have potential risks for knotting and lacerations of the PAC [6]. In the second case, the authors [4] reported early identification of entrapped PAC following mitral valve repair through observing blood returning from the thermistor connector and the need for resternotomy and re-institution of cardiopulmonary bypass (CPB) to remove an entrapped PAC in the surgical suture line.…”

“…Catheter knotting has also been described as a complication for using the PAC, mainly due to excessive insertion depth [12]. In contrast to the three cases published in the issue of JCVA, [3][4][5] surgical intervention was sometimes needed to remove the knotted PAC. Perez d' Empaire et al [13] described' successful surgical removal PAC knotted near the tricuspid valve and in the right ventricle likely because of too-deep inserting the PAC beyond 50 cm mark.…”

“…Gonzalez et al, [4] and Rawoot et al [5] on the postoperative difficulty of removing twisted knotted and entrapped PACs following heart transplantation and mitral valve repair surgery. Cohen et al [3] described the successful removal of the distal tip of knotted PAC beyond the superior vena cava through bedside cinching the knot tight to the introducer and removing them en-bloc through a cut down through the neck.…”

“…Gonzalez et al [4] presented two cases: the first for successful removal of entrapped PAC following repeated orthotopic heart transplantation through manipulating the non-included PAC in the surgical anastomosis under general anesthesia and combined fluoroscopy and transesophageal echocardiography (TEE) guidance in the operating room. Although manipulating the PAC by small, intermittent advancements, withdrawals, and twisting motions succeeded in removing the PAC intact through the introducer in this case, [4] repeated manipulations of the PAC might have potential risks for knotting and lacerations of the PAC [6].…”

“…Gonzalez et al [4] presented two cases: the first for successful removal of entrapped PAC following repeated orthotopic heart transplantation through manipulating the non-included PAC in the surgical anastomosis under general anesthesia and combined fluoroscopy and transesophageal echocardiography (TEE) guidance in the operating room. Although manipulating the PAC by small, intermittent advancements, withdrawals, and twisting motions succeeded in removing the PAC intact through the introducer in this case, [4] repeated manipulations of the PAC might have potential risks for knotting and lacerations of the PAC [6]. In the second case, the authors [4] reported early identification of entrapped PAC following mitral valve repair through observing blood returning from the thermistor connector and the need for resternotomy and re-institution of cardiopulmonary bypass (CPB) to remove an entrapped PAC in the surgical suture line.…”