Case Reports Swan-Ganz-Induced Pulmonary Artery Rupture: Management With Stent Graft Implantation Andrea Zuffi, 1 * MD, Giuseppe Biondi-Zoccai, 2 MD, and Federico Colombo, 1 MD Pulmonary artery catheterization is a useful tool for the diagnosis and management of lung or cardiac disease. This procedure is considered safe and associated with a low incidence of major complications. However, pulmonary artery rupture during right heart catheterization, albeit rare, remains a severe complication. Despite modern management with metal-coil embolization, selective intubation and deployment of bronchial blocker, the mortality rate may be as high as 50%. In this case, we report a new approach to deal with a Swan-Ganz-induced pulmonary artery rupture based on stent graft implantation leading to successful sealing of the pulmonary perforation with final patency and normal antegrade blood flow in the pulmonary branch. V C 2010 Wiley-Liss, Inc. Key words: pulmonary artery; rupture; stent; Swan-Ganz catheter INTRODUCTION The most serious complication related to Swan-Ganz catheter insertion is pulmonary artery rupture. Despite being rare (0.001%–0.47%), mortality due to iatrogenic pulmonary perforation ranges from 50 to 75% in anti- coagulated patients [1–3]. Death may occur for asphyxia caused by ipsi and contralateral pulmonary blood spillage [4] associated with lung atelectasis induced from bronchial blood clots. Modern manage- ment of pulmonary artery rupture consists of percuta- neous pulmonary artery or pseudoaneurysm emboliza- tion with metal coils and/or embolization agents such as n-butyl-cyanoacrylate [4–6]. If minimally invasive treatment is not available or feasible, surgical treatment (lobectomy, pneumonectomy, or pulmonary artery liga- tion with pulmonary artery repair) remains the only suitable option [7,8]. This case describes a Swan-Ganz- induced pulmonary artery rupture with acute severe hemoptysis successfully treated with the implantation of a stent graft. The originality of this case is the use of a typical interventional cardiology tool such as a stent graft to quickly solve a potential fatal complica- tion that can occur in all daily practice catheterization laboratories. CASE A 49-year-old man was admitted to our hospital for recent development of congestive heart failure. Trans- thoracic echocardiography showed a bicuspid aortic valve with severe regurgitation and left ventricular dil- atation (end-diastolic diameter 72 mm and end-systolic diameter 56 mm) and concomitant dilatation of the aor- tic root (maximum diameter 50 mm), mild-to-moderate mitral valve insufficiency secondary to anulus dilata- tion, as well as a small (0.5 mm) perimembranous ventricular septal defect with left-to-right shunt (DP 60 mmHg). Despite left ventricular dilatation, ejection fraction appeared still normal (55%). Right cardiac chambers were dilated with a mild hypertrophy of right ventricle and normal systolic function. Pulmonary artery pressure could not be reliably measured with echocardiography because of signal interference from the ventricular septal defect. 1 GVM Care and Research, Interventional Cardio-Angiology Unit, Cotignola, Italy 2 Division of Cardiology, University of Turin, Turin, Italy Conflict of interest: Nothing to report. *Correspondence to: Dr. Andrea Zuffi, MD, GVM Care and Research, Interventional Cardio-Angiology Unit, via Corriera 1, 48010 Cotignola (RA), Italy. E-mail: zuffiandrea@hotmail.com Received 23 February 2010; Revision accepted 10 March 2010 DOI 10.1002/ccd.22564 Published online 15 June 2010 in Wiley Online Library (wileyonlinelibrary.com) V C 2010 Wiley-Liss, Inc. Catheterization and Cardiovascular Interventions 76:578–581 (2010)