Pulmonary artery catheter placement in patients with a history of tricuspid ring annuloplasty, with pulmonary stenosis, and with the transvenous pacemaker leads: is it difficult?

PURPOSE: Previous case reports suggested that the presence of obstruction in the passage of the pulmonary artery catheter (PAC) may hinder its placement. However, little is known regarding the difficulty in proper placement of the PAC in those patients. This prospective observational study was designed to examine the difficulty in PAC placement in the patients with a possible obstruction in the passage of the PAC, and compare it with that of patients without those complications. METHOD: We measured the time required for placement of the PAC in adult patients with a history of tricuspid ring annuloplasty, with pulmonary artery stenosis or with transvenous pacemaker leads, and in patients without those history or complications (control). The flow-directed balloon-tipped PAC was placed under monitoring of pulmonary artery pressure wave. If the PAC was placed within 5 min, we regarded it was successful. We compared the success rate and the PAC placement time among the four groups of patients. RESULTS: The number of patients with a history of tricuspid ring annuloplasty, with pulmonary artery stenosis, with transvenous pacemaker leads and the control was 4, 1, 16, and 379, respectively. Placement of the PAC was successful in only one of the four patients with a history of tricuspid ring annuloplasty, and the success rate was significantly lower than the control patients (P < 0.001). We could finally place the PAC into the pulmonary artery under X-ray fluoroscopic photographing system in the other three patients. On the other hand, the PAC was successfully inserted in all patients with transvenous pacemaker leads and with pulmonary artery stenosis. CONCLUSION: Placement of a PAC under monitoring the pulmonary artery pressure waveform was difficult in a patient with history of tricuspid ring annuloplasty, but not in patients with transvenous pacemaker leads.