Hama Gentaku, Niitsu Hirokazu, Ishiwari Keiichi, Toyoda Yasuyuki, Kunihara Takashi
Department of Cardiovascular Surgery, Saku Central Hospital Advanced Care Center, Saku, Japan.
Kyobu Geka. 2022 Aug;75(8):598-601.
We herein present a case of massive intratracheal hemorrhage due to pulmonary artery catheter (PAC) use during triple valve surgery. A 75-year-old woman underwent biological aortic valve replacement along with mitral and tricuspid valve annuloplasty. Operative procedures were uneventful. Shortly after weaning from cardiopulmonary bypass, massive blood and froth filled the endotracheal tube. As her blood pressure and arterial oxygen saturation dropped, extracorporeal membrane oxygenation(ECMO) support through the right femoral artery and vein was promptly initiated. After the tip of the PAC was identified in the right pulmonary artery by chest Xray, an endobronchial blocker was used to protect the opposite lung. After clinical stability was achieved, she underwent pulmonary artery angiography and subsequent successful transcatheter embolization. Right heart unloading using ECMO and transcatheter embolization might have played key roles in the management of intraoperative pulmonary artery rupture.
我们在此报告一例在三瓣膜手术期间因使用肺动脉导管（PAC）导致大量气管内出血的病例。一名75岁女性接受了生物主动脉瓣置换术以及二尖瓣和三尖瓣瓣环成形术。手术过程顺利。在脱离体外循环后不久，大量血液和泡沫充满了气管内导管。随着她的血压和动脉血氧饱和度下降，立即通过右股动脉和静脉启动了体外膜肺氧合（ECMO）支持。通过胸部X线在右肺动脉中确定PAC尖端后，使用支气管内封堵器保护对侧肺。在临床稳定后，她接受了肺动脉血管造影并随后成功进行了经导管栓塞。使用ECMO进行右心减负和经导管栓塞可能在术中肺动脉破裂的处理中发挥了关键作用。
