Heart Catheterization Perforates Pulmonary Artery Causing Death

A 63-year-old African American female who had a history of diabetes, hypertension, chronic renal failure, congestive heart failure, GI bleed, on aggrenox and aspirin, no carotid artery disease, moderate to high pulmonary pressure and transient ischemic attacks had a left and right heart catheterization. The procedure was performed by at the Cath Lab.According to the operative note the following procedures were performed: a right heart catheterization, a selective coronary angiogram, and a left ventriculogram.

The right groin was chosen for the entry site and was cleaned and then injected with 2% lidocaine for local anesthesia. A modified Seldinger technique was used to access the right femoral artery and vein. The left heart catheterization, coronary angiogram, and left ventriculogram were performed first. The right heart catheterization was attempted. The pulmonary artery wedge pressure was measured, and immediately after the patient developed a cough and hemoptysis. Despite this, the physician “quickly” measured the pulmonary artery, right ventricular, and right atrial pressure. It was then noted that the patient developed hypotension and bradycardia. Advanced cardiovascular life support protocol was initiated and cardiopulmonary resuscitation was started. EMS was called to the cath lab. The patient was intubated. Once she was hemodynamically stable, the patin was transferred to the hospital where she passed away.

The death certificate lists the cause of death as left hemothorax due to perforation of pulmonary artery while undergoing cardiac catheterization. Is this malpractice or a known complication of a procedure performed within the standard of care.

MEDQUEST MEDICAL EXPERT OPINION:

I would consider this malpractice due to egregious poor technique.

While pulmonary artery rupture from right heart catheterization is reported, the proper technique under flouroscopy guidance and pressure guidance will avoid over dilation of the right heart catheter balloon, thereby avoiding pulmonary artery rupture. Dr BS – Cardiologist