e 2280 EuroIntervention 2017;12: e 2280- e 2282 published online e -ediition April 2017 DOI: 10.4244/EIJ-D-16-00576 © Europa Digital & Publishing 2017. All rights reserved. HOW SHOULD I TREAT? *Corresponding author: Hôpital Henri Mondor, Service des Explorations Fonctionnelles, Cardiologie Interventionnelle, 51 avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France. E-mail: madjid.boukantar@aphp.fr PRESENTATION OF THE CASE A 67-year-old woman was referred to our cardiology unit for ankle swelling and dyspnoea. Her medical history included a perma- nent atrial fibrillation treated with warfarin, a moderate tricuspid regurgitation treated with furosemide and a previously treated pul- monary tuberculosis. Her cardiovascular risk factors were arterial hypertension and diabetes mellitus. Clinical examination found signs of chronic right heart failure, an irregular rhythm, and a grade III/VI holosystolic murmur at the lower left sternal border on aus- cultation. Transthoracic echocardiography (TTE) revealed severe laminar tricuspid regurgitation due to an important annular dilata- tion, as measured by pulsed wave Doppler (Figure 1). Left ventric- ular ejection fraction was preserved (55%) and the tricuspid annular plane systolic excursion (TAPSE) was measured at 18 cm, suggest- ing preserved right ventricle function. Measurement of pulmonary artery pressure was not obtained because of the laminar tricuspid regurgitation. The case was discussed by our local Heart Team and it was decided that, according to ESC guidelines 1 , surgery (tricus- pid annuloplasty) was indicated. Pre-surgical right heart catheterisation was indicated in order to measure pulmonary artery pressure prior to the heart surgery. It was performed through a 7 Fr right femoral venous access, under local anaesthesia. International normalised ratio was 1.56 the day of the procedure. A Swan-Ganz™ catheter (Edwards Lifesciences, Irvine, CA, USA) was advanced into the right atrium under X-ray CASE SUMMARY BACKGROUND: A 67-year-old woman presenting with symptomatic laminar tricuspid regurgitation was referred to the cathlab for right heart catheterisation. A few sec- onds after the removal of the Swan-Ganz catheter, a mas- sive haemoptysis appeared, leading to life-threatening respiratory failure. INVESTIGATION: Clinical assessment, right heart cathe- terisation, pulmonary angiography. DIAGNOSIS: Pulmonary artery branch rupture. MANAGEMENT: A new Swan-Ganz catheter with inflated balloon was advanced in the injured pulmonary artery branch, allowing selective occlusion of the artery and con- trol of the haemoptysis. Then, selective embolisation of the ruptured artery with an AMPLATZER Vascular Plug was performed. KEYWORDS: AMPLATZER Vascular Plug, pulmonary artery rupture, pulmonary embolisation, Swan-Ganz catheter How should I treat a pulmonary artery rupture occurring during a right heart catheterisation in the cathlab? Madjid Boukantar 1 *, MD; Romain Gallet 1 , MD; Ketsakim You 2 , MD; Vania Tacher 2 , MD; Gauthier Mouillet 1 , MD; Hicham Kobeiter 2 , MD, PhD; Emmanuel Teiger 1 , MD, PhD 1. Henri Mondor Hospital, Explorations Fonctionnelles, Interventional Cardiology, Créteil, France; 2. Henri Mondor Hospital, Imagerie Médicale, Créteil, France Invited experts: Heike A. Hildebrandt 3 , MD; Tienush Rassaf 3 , MD; Philipp Kahlert 3 , MD; Younes Boudjemline 4,5 , MD, PhD 3. Department of Cardiology and Vascular Medicine, West German Heart and Vascular Center Essen, Essen University Hospital, University Duisburg-Essen, Essen, Germany; 4. Centre de Référence Malformations Cardiaques Congénitales Complexes - M3C, Hôpital Necker Enfants Malades, Assistance Publique des Hôpitaux de Paris, Paris, France; 5. Université Paris Descartes, Paris, France The concluding section “How did I treat?” together with the complete references and the supplementary data are published online at: http://www.pcronline.com/eurointervention/115th_issue/371