Right Heart Catheterization-Related Complications: A Review of the Literature and Best Practices

Right heart catheterization (RHC) is considered to be the gold standard for the measurement of pulmonary artery pressure and has a class 1 indication to confirm the diagnosis of pulmonary arterial hypertension and to guide treatment decisions. Associated complications with RHC in contemporary practice are uncommon. In this review, we aim to summarize the complications that have been published in case reports or case series with updated management and techniques to prevent and mitigate complications. We searched the PubMed database for the following reports: "right heart catheterization," "Swan-Ganz catheter," "pulmonary artery catheter," "balloon-tip catheter," and "complication" or "adverse event." Complications reported in 46 manuscripts were included in the final analysis. After evaluation of all reports, complications were grouped categorically. We found that the most commonly reported access site-related issues were either carotid artery injury or arteriovenous fistula formation, and injury to the tricuspid valve was the most commonly reported catheter-related complication. Our findings suggest that infrequent complications can occur with RHC and can be fatal. The optimal technique should be used to minimize complications. Operators should always be cautious during the procedure and monitor the patient closely.