Department of Cardiovascular Surgery, Maizuru Mutual Hospital, 1035 Hama, Maizuru, Kyoto 625-8585, Japan.
Heart Lung Circ. 2013 Dec;22(12):1040-2. doi: 10.1016/j.hlc.2013.04.114. Epub 2013 May 18.
A 68 year-old man presented with dyspnoea and chest pain. Computed tomography showed a massive bilateral pulmonary embolism. A 7.5 French pulmonary artery catheter (PAC) was inserted from the right internal jugular vein, and placed at the main pulmonary artery (PA) due to a thrombus in the distal PA. Continuous heparin sodium and urokinase infusions (240,000 units/day) were started. The PA pressure decreased gradually to within the normal range after two days. Three days after insertion, the PA waveform suddenly changed, he subsequently complained of chest pain, and the blood pressure rapidly decreased. Echocardiography demonstrated marked pericardial effusion. Computed tomography showed right ventricular perforation by the catheter, and contrast dye injection from the catheter tip demonstrated pericardial space enhancement. A median sternotomy was performed, and the perforation was detected in the anterior right ventricular wall. Direct buttress suture was placed, and the catheter was removed. He was subsequently discharged without any further complications. We encountered a rare case of postoperative RV perforation caused by a PAC. It is important to keep in mind that such a complication could arise not only during but also a few days after PAC insertion.
一位 68 岁男性因呼吸困难和胸痛就诊。计算机断层扫描显示双侧巨大肺栓塞。由于远端肺动脉内有血栓，从右侧颈内静脉插入了一根 7.5 法国肺动脉导管（PAC），并放置在主肺动脉（PA）中。开始持续输注肝素钠和尿激酶（每天 240,000 单位）。两天后，PA 压力逐渐降至正常范围内。插入后第三天，PA 波形突然改变，随后患者诉胸痛，血压迅速下降。超声心动图显示明显的心包积液。计算机断层扫描显示导管刺穿右心室，导管尖端注射造影剂显示心包增强。行正中胸骨切开术，在前右心室壁发现穿孔。直接支撑缝合，取出导管。随后患者无任何进一步并发症出院。我们遇到了一例罕见的由 PAC 引起的术后 RV 穿孔病例。需要注意的是，这种并发症不仅可能在 PAC 插入过程中发生，而且在插入几天后也可能发生。
