title: Perforation of the right ventricle induced by pulmonary artery catheter at induction of anesthesia for the surgery for liver transplantation: a case report and reviewed of literature.
abstract: We report a case of a 45-year-old male patient diagnosed with liver cirrhosis by hepatitis C and alcohol, with a Child-Pugh score C and a model for end-stage liver disease (MELD) score of 27, and submitted to liver transplantation. The subject underwent insertion of the pulmonary artery catheter (PAC) in the right internal jugular vein, with technical difficulty concerning catheter advance. There was sudden hypotension, increase in central venous pressure (CVP), and decrease in SvO(2) 15 minutes after the PAC had been inserted, followed by cardiorespiratory arrest in pulseless electrical activity (PEA), which was promptly assisted with resuscitation. Pericardiocentesis was performed without success, so the individual was subjected to a subxiphoid pericardial window, which led to output of large amounts of blood as well as PEA reversal to sinus rhythm. Sternotomy was performed; rupture of the apex of the right ventricle (RV) was detected, and suture of the site was accomplished. After hemodynamic stabilization, the patient was transferred to the ICU, where he developed septic shock and, despite adequate therapy, died on the eighteenth day after ICU admission.
authors.affiliation: Divisão de Terapia Intensiva, Departamento de Cirurgia e Anatomia, Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, 2o andar. Av. Bandeirantes, 3900 Bairro Monte Alegre, Ribeirão Preto, SP, Brazil.
authors.forename: Maria
authors.initials: M
authors.lastname: Auxiliadora-Martins
authors.forename: Erick
authors.initials: E
authors.lastname: Apinagés Dos Santos
authors.forename: Daniel
authors.initials: D
authors.lastname: Adans Wenzinger
authors.forename: Gil Cezar
authors.initials: GC
authors.lastname: Alkmim-Teixeira
authors.forename: Gerardo Cristino
authors.initials: GC
authors.lastname: de M Neto
authors.forename: Ajith Kumar
authors.initials: AK
authors.lastname: Sankarankutty
authors.forename: Orlando
authors.initials: O
authors.lastname: de Castro E Silva
authors.forename: Olindo Assis
authors.initials: OA
authors.lastname: Martins-Filho
authors.forename: Anibal
authors.initials: A
authors.lastname: Basile-Filho