Right-sided endocardial lesions and flow-directed pulmonary artery catheters1

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Sixty-five consecutive patients were examined at autopsy for the presence of right-sided endocardial lesions. Twenty-eight patients (43%) had undergone flow-directed pulmonary artery catheterization during their final hospital stay; of these, 10 (36%) had hemorrhagic and/or thrombotic lesions involving the right side of the heart and the pulmonary outflow tract. Lesions were rarely observed in patients who had not had indwelling catheters (P < 0.025). There were no cases of infective endocarditis. Of the 16 right-sided endocardial lesions identified, seven (44%) involved the right atrium, one (6%) the tricuspid valve, six (38%) the right ventricle, and two (12%) the pulmonic valve. Six patients (60%) had multiple lesions. A bacteremia/fungemia developed in seven patients (25%) with flow-directed pulmonary artery catheters and correlated with the duration of insertion (P < .005). Fatal Staphylococcus aureus septicemia with left ventricular abscess formation occurred in two patients. The authors conclude that endocardial trauma to the right side of the heart is not infrequent in patients with flow-directed pulmonary artery catheters. Systemic infection is also seen in this group, and, although secondary infection of the endocardium is uncommon, its potential occurrence must not be overlooked. The indication(s) for insertion of a pulmonary artery catheter must be carefully considered in each individual case.



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