Russo Roberta, Calzolari Alessandro, Salice Valentina, Micieli Camilla, Castiglioni Claudia, Gomarasca Mattia, Mondin Federico, Salihovic Bedrana Moro, Orsenigo Francesca, Negroni Davide, Migliorisi Carmelo, Lucchelli Matteo, Mistraletti Giovanni
Università degli Studi di Milano, Dipartimento di Fisiopatologia medico-chirurgica e dei trapianti, Milan, Italy; SC Rianimazione e Anestesia ASST Ovest Milanese, Legnano, Italy.
SC Rianimazione e Anestesia ASST Ovest Milanese, Legnano, Italy.
J Cardiothorac Vasc Anesth. 2025 Jan;39(1):215-219. doi: 10.1053/j.jvca.2024.10.017. Epub 2024 Oct 12.
This article discusses a pulmonary artery pseudoaneurysm (PAP) formation following pulmonary artery catheter (PAC) placement for cardiac surgery. The patient, an 82-year-old female with a history of hypertension and chronic heart failure, underwent elective mitral and tricuspid valve surgery. After surgery, bleeding was observed in the endotracheal tube, indicating a potential complication. Fiberoptic bronchoscopy revealed bleeding mainly in the right bronchus. Subsequent computed tomography pulmonary angiogram (CTPA) confirmed the presence of a small pseudoaneurysm in a branch of the pulmonary artery. Prompt collaboration between anesthesiologists, cardiac surgeons, and interventional radiologists led to the successful embolization of the pseudoaneurysm with a minimally invasive approach by using the PAC as a guide catheter to reach the PAP. The article outlines the potential causes of PAP formation, clinical presentation, and management strategies. While conservative, surgical, and interventional approaches are discussed, the preferred treatment is coil embolization due to its effectiveness and minimal invasiveness. The authors emphasize the importance of rapid diagnosis, multidisciplinary collaboration, and the feasibility of using the pulmonary artery route for embolization to rapidly reach the lesion to stabilize. Overall, the case demonstrates the successful resolution of a life-threatening complication through timely intervention and coordinated teamwork.
本文讨论了心脏手术放置肺动脉导管（PAC）后形成肺动脉假性动脉瘤（PAP）的情况。该患者为一名82岁女性，有高血压和慢性心力衰竭病史，接受了择期二尖瓣和三尖瓣手术。术后，观察到气管内导管有出血，提示可能存在并发症。纤维支气管镜检查显示出血主要在右支气管。随后的计算机断层扫描肺血管造影（CTPA）证实肺动脉一个分支存在一个小的假性动脉瘤。麻醉医生、心脏外科医生和介入放射科医生迅速协作，通过以PAC作为引导导管到达PAP，采用微创方法成功栓塞了假性动脉瘤。本文概述了PAP形成的潜在原因、临床表现和管理策略。虽然讨论了保守、手术和介入方法，但由于其有效性和微创性，首选治疗方法是弹簧圈栓塞。作者强调了快速诊断、多学科协作以及利用肺动脉途径进行栓塞以迅速到达病变部位使其稳定的可行性的重要性。总体而言，该病例展示了通过及时干预和团队协作成功解决危及生命的并发症。
