Matyal, Robina, Feroze Mahmood, Peter Panzica, John Mitchell, Sheila Barnett, Marybeth Hyde, David Campbell, and Kyung W Park. 2006. “Inadvertent Placement of a Flow-Directed Pulmonary Artery Catheter in the Coronary Sinus, Detected by Transesophageal Echocardiography.”. Anesthesia and Analgesia 102 (2): 363-5.
Abstract
We report a case in which flow-directed placement of the pulmonary artery catheter led to its inadvertent placement in the coronary sinus, in the absence of congenital anomalies. Incorrect placement was diagnosed by use of the transesophageal echocardiography. If unrecognized, the catheter might have provided misleading information and led to mismanagement of the patient.