Taghiyev Zulfugar T, Böning Andreas
Department of Cardiovascular Surgery, Justus-Liebig University Hospital, Rudolf-Buchheim Str. 7, Giessen, 35392, Germany.
BMC Anesthesiol. 2025 Sep 1;25(1):441. doi: 10.1186/s12871-025-03317-2.
The implantation of a Swan-Ganz catheter for invasive hemodynamic monitoring is an established measure after cardiac surgery. A rare but serious complication is the formation of a knot in the heart, which can be diagnostically challenging. We report on a patient who developed left heart failure postoperatively after quadruple bypass surgery combined with aortic valve replacement and in whom a knot formed inadvertently during monitoring using a Swan-Ganz catheter.
An 82-year-old female underwent combined quadruple coronary artery bypass grafting and aortic valve replacement for severe coronary and valvular heart disease. Postoperatively, she experienced acute left ventricular dysfunction, necessitating mechanical circulatory support with an Impella device. A Swan-Ganz catheter was placed through the internal jugular vein for accurate hemodynamic monitoring. After placement, unexpected catheter immobility raised suspicion of an intracardiac knot. Initial transthoracic echocardiography did not clearly visualize the lesion; however, subsequent chest radiography and jugular vein ultrasound confirmed catheter-associated intracardiac knot formation. Considering the heightened risk for cardiac injury and thromboembolic events, interdisciplinary consensus recommended bedside surgical extraction. The catheter and associated knot were successfully removed via transcutaneous vascular incision without complications. Inspection revealed knot formation proximal to the catheter thermistor, while the balloon remained intact and functional.
Intracardiac knot formation associated with Swan-Ganz catheter placement is rare but presents significant risks. Timely interdisciplinary assessment, multimodal imaging, and surgical extraction under controlled conditions effectively mitigate potential complications, enabling safe catheter removal and favorable patient outcomes.
植入Swan-Ganz导管进行有创血流动力学监测是心脏手术后的一项既定措施。一种罕见但严重的并发症是心脏内形成结，这在诊断上具有挑战性。我们报告了一名患者，该患者在接受四重搭桥手术联合主动脉瓣置换术后出现左心衰竭，并且在使用Swan-Ganz导管监测期间无意中形成了一个结。
一名82岁女性因严重冠状动脉和瓣膜性心脏病接受了四重冠状动脉搭桥术和主动脉瓣置换术联合手术。术后，她出现急性左心室功能障碍，需要使用Impella装置进行机械循环支持。通过颈内静脉放置了一根Swan-Ganz导管以进行精确的血流动力学监测。放置后，导管意外固定不动引发了对心内结的怀疑。最初的经胸超声心动图未能清晰显示病变；然而，随后的胸部X线检查和颈静脉超声证实了与导管相关的心内结形成。考虑到心脏损伤和血栓栓塞事件的风险增加，多学科共识建议在床边进行手术取出。通过经皮血管切开术成功取出了导管及相关的结，无并发症发生。检查发现结形成于导管热敏电阻近端，而球囊保持完整且功能正常。
与Swan-Ganz导管放置相关的心内结形成罕见但存在重大风险。及时的多学科评估、多模态成像以及在可控条件下进行手术取出可有效减轻潜在并发症，实现安全取出导管并使患者获得良好预后。
