• Kosin Medical Journal
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• v.33 no.2
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• pp.240-244
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• 2018

Knotting of a pulmonary artery catheter (PAC) is a rare, but well-known complication of pulmonary artery (PA) catheterization. We report a case of a double-knotted PAC with a large loop in a patient with hepatocellular carcinoma (HCC) undergoing liver transplantation, which has been rarely reported in the literature. A PAC was advanced under pressure wave form guidance. PAC insertion was repeatedly attempted and the PAC was inserted 80 cm deep even though PAC should be normally inserted 45 to 55 cm deep. However, since no wave change was observed, we began deflating and pulling the balloon. At the 30-cm mark, the PAC could no longer be pulled. Fluoroscopy confirmed knotting of the PAC after surgery (The loop-formed PAC was shown in right internal jugular vein); thus, it was removed. For safe PA catheterization, deep insertion or repeated attempts should be avoided when the catheter cannot be easily inserted into the pulmonary artery. If possible, the insertion of PACs can be performed more safely by monitoring the movement of the catheter under fluoroscopy or transesophageal echocardiography.

• Journal of Chest Surgery
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• v.25 no.4
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• pp.429-434
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• 1992

We experienced a rare case of traumatic ventricular septal defect by penetrating stab injury The patient was 26-year-old women who got stab wound at the left anterior third intercostal space and left sternal border with a knife. seven hours after admission, the patient was undertaken an emergency thoracotomy due to hypovolemic shock caused by massive bleeding from transected left internal mammary artery, vein, and right ventricular outflow tract. On postoperative second day, the patient was suffered from moderate dyspnea, and arterial blood gas analysis and chest X-ray revealed hypoxemia and pulmonary edema. Right heart cardiac catheterization with Swan-Ganz Cathater showed oxygen step-up between right atrium and main pulmonary artery and a 1.6:1 ratio of pulmonary to systemic blood flow. At operation, harsh systolic thrill was palpable along right ventricular outflow tract. Through small vertical right ventriculotomy, the linear ventricular septal laceration on infundibular septum was noticed, and its size was 1.5cm with sharp margin This defeat was repaired by three interrupted matress sutures using Prolene 4-O with pledget. Her postoperative course was uneventful, and she discharged with good physical condition.

• Journal of Yeungnam Medical Science
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• v.3 no.1
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• pp.301-306
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• 1986

Primary pericardial mesothelioma is a rare tumor of mesodermal origin that is infrequently diagnosed antemortem and survival is short. A 60 year old male case of pericardial mesothelioma(epitheloid type) is reported. He was admitted to Yeungnam University Hospital because of chest pain, dyspnea, orthopnea and nonproductive cough. Chest x-ray suggested pericardial effusion, 2-D echocardiography showed echo free spaces of massive pericardial effusion and areas of thick hyperrefractile echoes arising from the pericardium. Pericardiocentesis was attempted and aspirated fluid was bloody exudate. Pericardial window operation with biopsy was done. Swan-Ganz catheterization showed equalization between right atrial pressure and pulmonary capillary wedge pressure. The pathologic diagnosis was established by histologic finding at pericardial biopsy.

• Journal of Chest Surgery
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• v.32 no.3
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• pp.315-317
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• 1999

The complications associated with the use of pulmonary artery catheter include dysrhythmias, heart block, pulmonary artery rupture, pulmonary infarction, endocardial damage, balloon rupture, arterial puncture, thromboembolism, air embolism, infection, pneumothorax, and knotting of the catheter. Knotting of the catheter is a rare complication and it should be anticipated if there is an excessive advancement of the pulmonary artery catheter beyond the normally expected distance. We report a successful surgical removal of knotted pulmonary artery catheter by sternotomy and cardiopulmonary bypass.

• Journal of Chest Surgery
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• v.32 no.5
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• pp.422-427
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• 1999

Background: Tachycardia induced heart failure model would be the model of choice for the dilated cardiomyopathy. This more closely resembles the clinical syndrome and does not require major surgical trauma, myocardial ischemia and pharmacological or toxic depression of cardiac function. When heart failure is progressive, application of new surgical procedures to the faling heart is highly risky. It has been shown that recovery trajectory from heart failure is a new method in decreasing animal mortality. The purpose is to establish the control datas for recovery trajectory in the canine heart failure model. Material and Method: 21 mongrel dogs were studied at 4 stages(baseline, at the heart failure, 4 and 8 weeks after recovery). Heart failure was induced during 4 weeks of continuous rapid pacing using a pacemaker. Eight weeks of trajectory of recovery period was allowed. Indices of left ventricular function and dimension were measured every 2 weeks and the hemodynamics were measured by use of Swan-Ganz catheterization and thermodilution method every 4 weeks. Values were expressed as mean${\pm}$standard deviation. Result: 4(20%) dogs died due to heart failure. Left ventricular end-diastolic volume at the 4 stages were 40.8${\pm}$7.4, 82.1${\pm}$21.1, 59.9${\pm}$7.7 and 46.5${\pm}$6.5ml. Left ventricular end-systolic volume showed the same trend. Ejection fractions were 50.6${\pm}$4.1, 17.5${\pm}$5.8, 36.3${\pm}$7.3, and 41.5${\pm}$2.4%. Blood pressure and heart rate showed no significant changes. Pressures of central vein, right ventricle, pulmonary artery, and pulmonary capillary wedge showed significant increase during the heart failure period, normalizing at the end of recovery period. Stroke volumes were 21.5${\pm}$8.2, 12.3${\pm}$3.5, 17.9${\pm}$4.6, and 15.5${\pm}$3.4ml. Blood norepinephrine level was 133.3${\pm}$60.0pg/dL at the baseline and 479.4${\pm}$327.3pg/dL at the heart failure stage(p=0.008). Conclusion: Development of tachycardia induced heart failure model is of high priority due to ready availability and reasonable amenability to measurements. Recovery trajectory after cessation of tachycardia showed reduction of cardiac dilatation and heart function. Application of new surgical procedures during the recovery period could decrease animal mortality.