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Indwelling cardiac catheters. An autopsy study of associated endocardial lesions
Insights
Indwelling intracardiac catheters frequently cause right heart lesions, including hemorrhage and infective endocarditis. Swan-Ganz catheters are associated with more severe lesions and pulmonary emboli.
Area of Science:
- Cardiovascular Pathology
- Medical Devices
Background:
- Indwelling intracardiac catheters are common in critical care.
- Potential complications include endocardial and valvular damage.
Purpose of the Study:
- To investigate the association between intracardiac catheters and right heart lesions.
- To characterize the types and severity of lesions related to catheter use.
Main Methods:
- Autopsy study of cardiac tissue.
- Histopathological examination for hemorrhagic, thrombotic, and infective lesions.
- Correlation with indwelling catheter use, including Swan-Ganz catheters.
Main Results:
- Intracardiac catheters frequently induce right heart endocardial and valvular lesions.
- Lesions range from hemorrhage to infective endocarditis.
- Swan-Ganz catheters were linked to more frequent and severe lesions, and pulmonic valve damage.
- Thrombotic and infective lesions were associated with pulmonary emboli.
Conclusions:
- Indwelling intracardiac catheters are a significant cause of right heart pathology.
- Catheter material and duration of use influence lesion development.
- Further research is needed to understand catheter-independent hemorrhages.
Abstract:
An autopsy study was carried out to assess the relationship between indwelling intracardiac catheters and hemorrhagic, thrombotic, and infective lesions of the right heart endocardium and valve. Intracardiac catheters cause such lesions frequently, with a spectrum from uncomplicated valvular hemorrhage through nonbacterial thrombotic endocarditis to infective endocarditis. Pulmonary emboli were associated with the thrombotic, infective lesions. Endocardial lesions are more commonly seen with Swan-Ganz (SG) catheters; with these, lesions are more common and severe, with longer periods of catheterization. Pulmonic-valve lesions were only seen with SG catheters. However, not all hemorrhagic lesions in the right heart endocardium were associated with catheters, because a few inpatients without catheters had small subendocardial valvular hemorrhages; the cause of these hemorrhages is obscure because they were not seen in the hearts of patients who died outside the hospital.