PMID- 23075214
OWN - NLM
STAT- MEDLINE
DCOM- 20140226
LR  - 20161125
IS  - 1747-0803 (Electronic)
IS  - 1747-079X (Linking)
VI  - 8
IP  - 4
DP  - 2013 Jul-Aug
TI  - Wire-related pulmonary artery injury during pediatric and adult congenital 
      interventional cardiac catheterization.
PG  - 296-301
LID - 10.1111/chd.12015 [doi]
AB  - OBJECTIVES: Guidewires used in pediatric catheterization are typically floppy, 
      soft, or J-tipped, and are generally assumed to be atraumatic. A recent sentinel 
      case suggested that such wires may cause clinically significant pulmonary artery 
      (PA) injury. We sought to determine the incidence of wire-related PA injury as a 
      cause of "idiopathic" airway bleeding (endobronchial blood) during interventional 
      cardiac catheterization in patients with congenital heart disease. DESIGN: The 
      Children's Hospital Boston database of cardiac catheterizations was reviewed for 
      adverse events (AEs) indicating possible PA injury occurring between September 
      2006 and August 2011. Procedure notes were reviewed, and when the clinical 
      scenario was suggestive of wire injury or was not clear, relevant angiograms were 
      reviewed. RESULTS: One thousand forty-seven cases involving PA dilation were 
      performed in the period of interest. Five cases of probable wire injury were 
      identified, suggesting an incidence of approximately 0.5 per 100 cases. Of these 
      five cases, trauma was judged due to floppy-tipped wires in two, soft-tipped 
      wires in two, and a J-tipped wire in one. In three cases, the distal wire was 
      looped such that the leading segment was stiffer than the wire tip. Clinical 
      manifestations of wire injury comprised contrast within the airway, vessel 
      aneurysm/tear, obstructive intimal flap, blood from the endotracheal tube, 
      hemothorax, and wedge defect on lung scan. These injuries were relatively benign 
      and did not result in instability or prolonged bleeding. CONCLUSIONS: Wire injury 
      to the PAs is relatively uncommon, although possible with even floppy-tipped 
      wires. The mechanism and implications of such injuries are markedly different 
      than balloon-mediated vascular tears.
CI  - (c) 2012 Wiley Periodicals, Inc.
FAU - Esch, Jesse J
AU  - Esch JJ
AD  - Department of Cardiology, Children's Hospital Boston, Boston, MA 02115, USA.
FAU - Bergersen, Lisa
AU  - Bergersen L
FAU - McElhinney, Doff B
AU  - McElhinney DB
FAU - Porras, Diego
AU  - Porras D
FAU - Lock, James E
AU  - Lock JE
FAU - Marshall, Audrey C
AU  - Marshall AC
LA  - eng
PT  - Case Reports
PT  - Journal Article
DEP - 20121018
PL  - United States
TA  - Congenit Heart Dis
JT  - Congenital heart disease
JID - 101256510
SB  - IM
MH  - Adult
MH  - Aged
MH  - Boston/epidemiology
MH  - Cardiac Catheterization/*adverse effects/instrumentation
MH  - Cardiac Catheters
MH  - Child
MH  - Child, Preschool
MH  - Databases, Factual
MH  - Equipment Design
MH  - Female
MH  - Heart Defects, Congenital/diagnosis/*therapy
MH  - Hemorrhage/epidemiology
MH  - Hospitals, Pediatric
MH  - Humans
MH  - Incidence
MH  - Infant
MH  - Male
MH  - Pulmonary Artery/diagnostic imaging/*injuries
MH  - Radiography
MH  - Time Factors
MH  - Vascular System Injuries/diagnosis/*epidemiology
OTO - NOTNLM
OT  - Complications
OT  - Trauma
OT  - Vascular
EDAT- 2012/10/19 06:00
MHDA- 2014/02/27 06:00
CRDT- 2012/10/19 06:00
PHST- 2012/09/06 00:00 [accepted]
PHST- 2012/10/19 06:00 [entrez]
PHST- 2012/10/19 06:00 [pubmed]
PHST- 2014/02/27 06:00 [medline]
AID - 10.1111/chd.12015 [doi]
PST - ppublish
SO  - Congenit Heart Dis. 2013 Jul-Aug;8(4):296-301. doi: 10.1111/chd.12015. Epub 2012 
      Oct 18.