Right heart catheter lesions: any significance?

In order to determine whether endocardial lesions that developed in relation to an indwelling catheter in the right heart had any significance or characteristics, a study with clinicopathologic correlations was performed in which a total of 57 hearts were found to have right heart endocardial lesions at necropsy. Some of our findings fall within the range of results of various similar studies, e.g., clinical backgrounds and incidence in which these lesions occur. However, others do not; pulmonary embolism was preexisting and coexisting rather than attributable to the heart lesions. Right heart lesions occur significantly more often (P less than 0.01) in patients who received a right heart catheter than those who did not. The morphologic features of these endocardial lesions are sufficiently characteristic to indicate not only that an intracardiac catheter had been present but even what type of catheter it was. Infective endocarditis was found in seven catheterized patients. This process has a tendency to involve valves transmurally, indicating possible need for prosthetic valve replacement if any patients were to survive the underlying disease. Traumatic perforation of the endocardium was uncommon. With the aid of careful indications and strict adherence to guidelines, the risk of fatality from these lesions is extremely unlikely.