[Non-surgical removal of a knotted Swan-Ganz catheter]

Intracardiac knotting is a rare complication of pulmonary arterial catheterization. This paper describes a 68-year-old male patient who had a 7-F Swan-Ganz catheter inserted via the internal jugular vein. The postoperative chest roentgenogram revealed a catheter knot in the right ventricle. Using fluoroscopy it was possible to pull back the knot up to the indwelling introducer. By pulling the knot against the introducer its size was reduced to a minimum. After this manoeuvre, both the introducer and the small knot could be withdrawn from the jugular vein without further incident. The possible complications of this method and of alternative techniques are described and discussed. Surgical intervention in the case of a knotted Swan-Ganz catheter may only be necessary when intracardiac fixing of the knot is encountered.