Right Heart Catheterization-Related Complications: A Review of the Literature and Best Practices

Right heart catheterization is common enough to feel routine. This review is a catalog of the ways it can go wrong — and how to keep it from doing so.

Drawing on case reports and series, the authors sort the complications by source: access-related injuries such as carotid puncture and arteriovenous fistula, and catheter-related ones, most notably injury to the tricuspid valve as the catheter passes through it. The events are rare, but some are fatal — which is the point. The countermeasure is unglamorous: meticulous technique and vigilant monitoring.

The practical takeaway is a safety mindset for proceduralists. The status-quo friction the authors flag is the discomfort of high-volume centers in dwelling on the risks of a bread-and-butter procedure.

We rate the evidence low: a useful but case-report-based literature review, a design prone to reporting bias, and several authors are high-volume interventionalists with attendant potential conflicts. Its clinical significance is moderate and narrow — genuinely valuable for the people performing the procedure, but confined to that specific population. Safety guidance, not a change in who should be catheterized.