Obstruction of pulmonary artery catheterization because of lipomatous hypertrophy of the interatrial septum

COMPLICATIONS WITH CORRECT POSITIONING of a Pulmonary artery catheter are not uncommon in the perioperative and intensive care settings.' Common causes of difficult placement include misdirection into the innominate vein or inferior vena cava, curling of the catheter in the right ventricle, the obstructing presence of multiple pacemaker wires, low-output states, and hypovolemia. In addition, structural abnormalities may hinder successful catheterization. Lipomatous hypertrophy of the interatrial septum (LHIS) is a common anatomic variant that results from fatty infiltration of the septum with sparing of the fossa ovalis.(2) The authors report a case in which pulmonary artery catheterization was impeded by LHIS. Transesophageal echocardiography (TEE) was used to facilitate the passage of the catheter beyond the obstruction.