• J M Porter, R Page, A E Wood, and D Phelan.
• Department of Anaesthesia, Intensive Care and Cardiac Surgery, Mater Hospital, Dublin, Ireland.
• Can J Anaesth. 1997 Mar 1; 44 (3): 317-20.

PurposeCardiac perforation is a recognised complication of guidewire-introducer techniques. These two new cases of right ventricular perforation implicate the dilator-introducer: one directly and the other due to presumed guidewire buckling.Clinical FeaturesAn 85-yr-old man underwent right subclavian cannulation for triple-lumen and pulmonary artery (PA) catheter insertion before coronary artery surgery. Tachycardia (120 bpm) and hypotension (60/30 mmHg) evolved over the next 40 min and resolved with evacuation of 200 ml of clot from the pericardial sac. A ragged 4 mm laceration of the ventricular wall was localised and oversewn without further consequence. A 60-yr-old man with inferior vena caval thrombosis was scheduled for Greenfield filter insertion. The right internal jugular vein was cannulated using the guidewire-introducer technique. Introduction of the introducer-dilator system precipitated cardiovascular collapse. Resuscitation was unsuccessful and post-mortem revealed right ventricular perforation and pericardial tamponade.ConclusionThese cases suggest that shorter introducer-dilators would be safer and probably equally efficacious. The need for a high index of suspicion and rapid therapeutic intervention is also highlighted.

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