How should I treat a pulmonary artery rupture occurring during a right heart catheterisation in the cathlab?

A 67-year-old woman was referred to our cardiology unit for ankle swelling and dyspnoea.Her medical history included a permanent atrial fibrillation treated with warfarin, a moderate tricuspid regurgitation treated with furosemide and a previously treated pulmonary tuberculosis.Her cardiovascular risk factors were arterial hypertension and diabetes mellitus.Clinical examination found signs of chronic right heart failure, an irregular rhythm, and a grade III/VI holosystolic murmur at the lower left sternal border on auscultation.Transthoracic echocardiography (TTE) revealed severe laminar tricuspid regurgitation due to an important annular dilatation, as measured by pulsed wave Doppler (Figure 1).Left ventricular ejection fraction was preserved (55%) and the tricuspid annular plane systolic excursion (TAPSE) was measured at 18 cm, suggesting preserved right ventricle function.Measurement of pulmonary artery pressure was not obtained because of the laminar tricuspid regurgitation.The case was discussed by our local Heart Team and it was decided that, according to ESC guidelines 1 , surgery (tricuspid annuloplasty) was indicated.Pre-surgical right heart catheterisation was indicated in order to measure pulmonary artery pressure prior to the heart surgery.It was performed through a 7 Fr right femoral venous access, under local anaesthesia.International normalised ratio was 1.56 the day of the procedure.A Swan-Ganz™ catheter (Edwards Lifesciences, Irvine, CA, USA) was advanced into the right atrium under X-ray CASE SUMMARY BACKGROUND: A 67-year-old woman presenting with symptomatic laminar tricuspid regurgitation was referred to the cathlab for right heart catheterisation.A few seconds after the removal of the Swan-Ganz catheter, a massive haemoptysis appeared, leading to life-threatening respiratory failure.