Four instances of accidental puncture of the heart during venous cardiac catheterization are described. Two of these punctures were of right auricular appendages, and two were of thick hypertrophied right ventricles. All instances were in infants less than 4 months old. In two cases death occurred as the direct result of the accident, in one the accident was the precipitating cause, while in the fourth case there was no recognition of the episode and the evidence was discovered accidentally at surgery several weeks later. Some possible causal factors were subjected to experimental study. It is concluded that persistence in catheter manipulation plays a considerable role and must be tempered by judgment of the patient's needs. Excessive stiffness of the catheter must be avoided in selection and sterilization. The small infant especially presents the risk of catheter puncture because of the short distance between the point of application of force and its point of contact with the heart. The infant also has a very narrow "venous sleeve" through which the catheter is passed, thereby producing more rigidity by extrinsic support. Thus the possibility of cardiac puncture is an important reason for deferring catheterization at least beyond the age of 6 months if possible. If it must be performed early, it should be with concern and preparation for this eventuality. If puncture is recognized, the catheter tip should be left in the pericardial sac until the wound is surgically closed.
- Copyright © 1962 by the American Academy of Pediatrics