Pulmonary Artery Perforation From Right Heart Catheterization

BACKGROUND: Pulmonary artery perforation is an uncommon complication of right heart catheterization (RHC), with potentially lethal consequences. CASE SUMMARY: An older woman undergoing transcatheter edge-to-edge repair under general anesthesia, had sudden bleeding from her endotracheal tube after RHC. This was followed by de-saturation and drop in blood pressure. Repeat RHC demonstrated left pulmonary artery perforation and pseudoaneurysm. Following wedge balloon occlusion of the perforation, a second femoral access was used to deliver a 12-mm Amplatzer vascular plug to seal the neck. The ping pong technique controlled active bleeding and allowed for successful device delivery for definitive management. DISCUSSION: Pulmonary artery perforation is both a rare and lethal complication that requires rapid diagnosis and treatment. TAKE-HOME MESSAGES: Respiratory tract bleeding following RHC should be considered pulmonary artery perforation until proven otherwise. The Ping Pong Guide technique is a feasible and safe treatment option.