False Aneurysm of the Pulmonary Artery: A Complication of Pulmonary Artery Catheterization

A case of Swan-Ganz catheter–induced pulmonary artery injury is discussed. Iatrogenic pulmonary artery injury probably occurs more frequently than is clinically suspected. Pulmonary angiography is urged when hemoptysis occurs in a patient with an indwelling pulmonary artery catheter.     

Recurrent Coarctation of the Thoracic Aorta: Subclavian Flap Arterioplasty with Carotid Reimplantation of the Distal Subclavian Artery

Combining a subclavian flap procedure and reimplantation of the distal subclavian artery into the left carotid artery was used in 2 patients with recurrent coarctation of the thoracic aorta. One of the patients was 12 years old and the other, 6 years old.The operation has several advantages. (1) It is very efficient in relieving recurrent gradients. (2) The use of prosthetic material is avoided. (3) Minimal dissection is required. (4) It prevents subsequent subclavian steal syndrome and long-term ischemia of the left upper limb.     

Aberrant Right Subclavian Artery Aneurysm

Ten patients with aneurysm of an aberrant right subclavian artery have been previously reported. Dysphagia is not commonly part of the initial symptomatology, and the diagnosis is usually established by chest roentgenogram, esophagogram, and aortography. If operative intervention is planned, adequate preparation for bypass and thoracic aortic grafting should be made since the aneurysm may also involve the descending thoracic aorta at the site of origin of the aberrant subclavian artery.Since both ischemia of the involved arm and the subclavian steal syndrome may occur after division of the origin of the subclavian artery, restoration of arterial flow in the distal subclavian artery is preferred. An additional patient is reported in whom right subclavian-to-carotid artery anastomosis was used after the subclavian artery aneurysm was removed.     

Pulmonary Artery Sling

A case of pulmonary artery sling in a 1-year-old boy, treated by resection of the left pulmonary artery (LPA) at its origin from the right pulmonary artery (RPA) and reanastomosis of the LPA to the main pulmonary artery (MPA), is reported. In this patient the LPA-MPA anastomosis was demonstrated to be patent in a follow-up pulmonary angiogram six months after the operation. Pulmonary artery sling should be kept in mind when assessing respiratory distress syndrome in children.