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Transesophageal Echocardiography Should Be Considered During Pulmonary Artery Catheter Insertion in Cardiac Surgery.

The pulmonary artery catheter (PAC) is a hemodynamic monitor commonly used during cardiac surgery. Conventionally, the PAC is inserted intraoperatively using the pressure waveform transduction technique. The measurement of changes in pressure as the PAC traverses the superior vena cava to the main pulmonary artery helps guide PAC insertion. This approach to PAC insertion, however, can be challenging in patients with certain pathologic conditions such as: systolic heart failure, moderate-to-severe tricuspid regurgitation, right atrial enlargement, right ventricular enlargement, right ventricular outflow tract obstruction, and in those with intracardiac leads. As a consequence, multiple attempts may be required during PAC insertion using the pressure waveform transduction technique, which may lead to complications such as arrhythmias, PAC kinking, tricuspid valve injury, and pulmonary artery injury. Considering that the pressure transduction technique does not provide the operator the ability to visualize the location of the PAC during insertion, transesophageal echocardiography (TEE) may be of value during PAC placement. In a prior issue of the Journal, Cronin et al reported on the successful use of TEE guidance for PAC catheter insertion in 20 patients with chronic thromboembolic pulmonary hypertension undergoing pulmonary thromboendarterectomy. During PAC placement, 11 of 20 patients required PAC manipulation