VENTRICULAR PERFORATION ASSOCIATED WITH CENTRAL VENOUS INTRODUCER-DILATOR SYSTEMS

Purpose: Cardiac perforation is a recognised complication of guidewire -introducer techniques. These two new cases of right ventricular perfo ration implicate the dilator-introducer: one directly and the other du e to presumed guidewire buckling. Clinical Features: An 85-yr-old man underwent right subdavian cannulation for triple-lumen and pulmonary a rtery (PA) catheter insertion before coronary artery surgery. Tachycar dia (120 bpm) and hypotension (60/30 mmHg) evolved over the next 40 mi n and resolved with evacuation of 200 mi of clot from the pericardial sac. A ragged 4 mm laceration of the ventricular wall was localised an d oversewn without further consequence. A 60-yr-old man with inferior vena caval thrombosis was scheduled for Greenfield filter insertion. T he right internal jugular vein was cannulated using the guidewire-intr oducer technique. Introduction of the introducer-dilator system precip itated cardiovascular collapse. Resuscitation was unsuccessful and pos t-mortem revealed right ventricular perforation and pericardial tampon ade. Conclusion: These cases suggest that shorter introducer-dilators would be safer and probably equally efficacious. The need for a high i ndex of suspicion and rapid therapeutic intervention is also highlight ed.