Morita Mariko, Inoue Hiroshi, Ota Takahisa, Tohi Yasuaki, Tsutsumi Yusuke, Ito Jun, Uchida Hiroaki
Masui. 2016 Sep;65(9):969-971.
We report a case of pulmonary artery catheter (PAC) injury by radio frequency device for maze procedure. A 64-year-old female with severe mitral insufficiency, tricuspid insufficiency and paroxysmal atrial fibrillation was scheduled for mitral valve repair, tricuspid annulo- plasty and maze procedure including right-sided maze. Under general anesthesia, a PAC was inserted to pul- monary artery (PA) uneventfully. After radio frequency maze procedure and mitral valve repair, PAC was removed from right atrium by the surgeon for tricus- pid annuloplasty. Thereafter, the surgeon reinserted the PAC under transesophageal echocardiographic guidance since PAC balloon could not be inflated. PA pressure and cardiac output were not shown despite other parameters were correct We removed the PAC and reinserted a new one after the surgery. The PAC was compressed at about 25 cm from the tip and it appears to have been injured during right-sided maze procedure with radio frequency device. Complications of PAC are well known, including PA rupture and suture entrapment to the right atrium. To best of our knowledge, this is the first reported case of PAC injury by radio frequency device. Fortunately the PAC was not torn in our case ; however, there might have been a risk of infection through the thermodilu- tion cable.
我们报告了一例在迷宫手术中使用射频设备导致肺动脉导管（PAC）损伤的病例。一名64岁女性，患有严重二尖瓣关闭不全、三尖瓣关闭不全和阵发性心房颤动，计划接受二尖瓣修复、三尖瓣环成形术以及包括右侧迷宫手术在内的迷宫手术。在全身麻醉下，肺动脉导管顺利插入肺动脉（PA）。在进行射频迷宫手术和二尖瓣修复后，外科医生为了进行三尖瓣环成形术将肺动脉导管从右心房取出。此后，由于肺动脉导管球囊无法充气，外科医生在经食管超声心动图引导下重新插入了肺动脉导管。尽管其他参数正确，但肺动脉压力和心输出量未显示。术后我们取出了肺动脉导管并重新插入了一根新的。肺动脉导管在距尖端约25厘米处受压，似乎是在右侧迷宫手术中使用射频设备时受到了损伤。肺动脉导管的并发症是众所周知的，包括肺动脉破裂和缝线陷入右心房。据我们所知，这是首例报道的射频设备导致肺动脉导管损伤的病例。幸运的是，在我们的病例中肺动脉导管没有撕裂；然而，通过热稀释电缆可能存在感染风险。
