Pulmonary artery laceration by a pulmonary artery catheter: a case report and review of the literature.

A 74-year-old white man with unstable angina underwent an uneventful urgent four-vessel coronary bypass operation at which time a Tenkhoff catheter was placed because of renal insufficiency. Two hours following arrival in the intensive care unit, the patient demonstrated hemodynamic instability, progressive acidosis, and a fall in his hematocrit from 35% to 18%. In retrospect, this instability was initiated by wedging of the pulmonary artery catheter. Hemorrhagic complications involving the use of flow-directed, balloon-tipped catheters are rare following cardiopulmonary bypass operations. The estimated incidence is reported at 1 to 2 per 1,000, although many may go unreported. The mortality rate is in excess of 50%. We report a case of a successfully repaired laceration of the pulmonary artery caused by a pulmonary artery catheter following cardiac surgery, and provide a review of the literature. As illustrated by this case and emphasized in the literature, salvage of patients who suffer this complication requires a high index of suspicion in order to rapidly recognize the injury and intervene with the appropriate therapy.