J Cardiovasc Surg
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In over 3500 consecutive open heart procedures using Swan-Ganz catheterization at our institution, we have experienced three major pulmonary artery injuries secondary to this procedure. Pulmonary artery hemorrhage is a rare but frequently fatal complication and a mortality rate as high as fifty percent has been reported. In two of these cases, major retraction of the heart was needed for adequate exposure of the cardiac pathology. ⋯ The authors have recommended steps to be taken when massive hemoptysis occurs and Swan-Ganz catheter perforation of the pulmonary artery is suspected. Re-evaluation of the "routine" use of the Swan-Ganz catheter may be necessary and overutilization may be a distinct possibility. When the use of this catheter is deemed appropriate, a more exact positioning of the distal portion of the catheter is mandatory if pulmonary artery perforation is to be avoided.