[Perforation of the cardiac wall during central venous catheterization - muscular defects as a contributing factor (author's transl)].

Two cases of perforation of the cardiac wall during central venous catheterization are reported. One patient, a women, died 6 weeks after perforation of the anterior wall of the right ventricle; the other, also a woman, died immediately following perforation of the posterior wall of the right atrium by a polyethylene catheter. Both cases prove that even a seemingly correct technique and the use of soft catheters cannot entirely exclude the possibility of perforation. Relative weakness of the cardiac muscle due to lipomatosis could have been a pre-disposing factor in one case, and thinning of the atrial wall between the pectinate muscles in the other case. There is also the possibility that the spaces between the trabeculae carneae act as a trap for the catheter. Radiological control of the placement of the catheter should also be performed in those cases where the catheter had to be withdrawn because of malposition in order to make sure of its correct extracardial location.