Ventricular perforation associated with central venous introducer-dilator systems.
OBJECTIVE
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.


METHODS
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.


CONCLUSIONS
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.
Porter
J M
JM
Department of Anaesthesia, Intensive Care and Cardiac Surgery, Mater Hospital, Dublin, Ireland.
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Phelan
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D000368:Aged; D000369:Aged, 80 and over; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D006335:Heart Injuries / Q000209:etiology*; D006352:Heart Ventricles / Q000293:injuries*; D006801:Humans; D008297:Male; D008875:Middle Aged