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Canadian Journal of Anesthesia, Vol 44, 317-320, Copyright © 1997 by Canadian Anesthesiologists' Society

ARTICLES

Ventricular perforation associated with central venous introducer-dilator systems

JM Porter, R Page, AE Wood and D Phelan
Department of Anaesthesia, Intensive Care and Cardiac Surgery, Mater Hospital, Dublin, Ireland.

PURPOSE: Cardiac perforation is a recognised complication of guidewire-introducer techniques. These two new cases of right ventricular perforation implicate the dilator-introducer: one directly and the other due to presumed guidewire buckling. CLINICAL FEATURES: An 85-yr-old man underwent right subclavian cannulation for triple-lumen and pulmonary artery (PA) catheter insertion before coronary artery surgery. Tachycardia (120 bpm) and hypotension (60/30 mmHg) evolved over the next 40 min and resolved with evacuation of 200 ml of clot from the pericardial sac. A ragged 4 mm laceration of the ventricular wall was localised and oversewn without further consequence. A 60-yr-old man with inferior vena caval thrombosis was scheduled for Greenfield filter insertion. The right internal jugular vein was cannulated using the guidewire-introducer technique. Introduction of the introducer-dilator system precipitated cardiovascular collapse. Resuscitation was unsuccessful and post-mortem revealed right ventricular perforation and pericardial tamponade. CONCLUSION: These cases suggest that shorter introducer-dilators would be safer and probably equally efficacious. The need for a high index of suspicion and rapid therapeutic intervention is also highlighted.


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Copyright © 1997 by the Canadian Anesthesiologists' Society.