Catheter entrapment by atrial suture during minimally invasive port-accesscardiac surgery

Purpose: The port-access approach allows surgeons to perform heart operatio ns through small intercostal openings, or "ports", This technique requires new skills for anesthesiologists. A pulmonary artery venting (PAV) catheter and, in some cases, a coronary sinus catheter (for administration of retro grade cardioplegia) are positioned with the aid of fluoroscopy and transeso phageal echography (TEE), Both catheters have a wider diameter than the mor e commonly used conventional PA catheter and present distinctive features. We report a case in which a pulmonary artery venting catheter was entrapped by a suture during a port-access procedure. Clinical Features: A 35-yr-old man with severe mitral valve insufficiency w as scheduled for valve repair. After a successful bypass procedure, resista nce was felt while attempting to withdraw the PAV catheter, On fluoroscopy, fixation of the catheter at-the heart level was established and perforatio n by suture was confirmed after injection of a contrast agent. Because of t he risk of cardiac wail rupture and tamponade, the thorax was reopened. Aft er release of some atrial sutures, the catheter could be withdrawn easily T ransfixion by a suture was confirmed by visual examination. Conclusion: The more frequent use of a PAV catheter in minimally invasive c ardiac surgery with the port-access technique should remind the anesthesiol ogist of the higher risk of entrapment by surgical sutures. Surgeons should be aware of the risk of accidentally transfixing this catheter during clos ure of the atriotomy via the port.