Nakamura Yuta, Saku Keita, Homma Suzu, Midorikawa Yoko, Yamabe Tsuyoshi, Ota Takashi
Department of Anesthesiology, Shonan Kamakura General Hospital, Kamakura, Japan.
Department of Cardiovascular Dynamics, National Cerebral and Cardiovascular Center Research Institute, Suita, Japan.
Front Cardiovasc Med. 2025 Apr 28;12:1567723. doi: 10.3389/fcvm.2025.1567723. eCollection 2025.
The pulmonary artery catheter (PAC) is widely used in cardiac surgery for monitoring hemodynamics and cardiovascular function. Complications including pulmonary artery injury causing massive intratracheal hemorrhage are rare but can be life-threatening. We report a case of intratracheal bleeding (3,000 ml) caused by PAC-induced pulmonary artery injury during cardiac surgery and after weaning from cardiopulmonary bypass (CPB). During surgery for acute type A aortic dissection followed by CPB weaning, pulsatile bleeding from the endotracheal tube and desaturation were observed. We reinstituted CPB and placed a right-sided double-lumen tube to compress the injured site of the lung and protect the contralateral site. Following initial bleeding control, we conducted coil embolization to treat tracheal obstruction by a pseudoaneurysm on day 7. A review of 21 recent cases of pulmonary artery injury during cardiac surgery showed that most cases occurred during CPB weaning, manifested hemoptysis, and were treated by coil embolization. This case underscores the importance of enhanced PAC monitoring even after CPB weaning and the need for prompt evaluation and intervention when pulmonary artery injury is suspected during cardiac surgery.
肺动脉导管（PAC）在心脏手术中被广泛用于监测血流动力学和心血管功能。包括导致大量气管内出血的肺动脉损伤在内的并发症虽罕见，但可能危及生命。我们报告一例心脏手术期间及体外循环（CPB）撤机后由PAC引起的肺动脉损伤导致气管内出血（3000毫升）的病例。在急性A型主动脉夹层手术及CPB撤机过程中，观察到气管插管出现搏动性出血和血氧饱和度下降。我们重新启动CPB并置入右侧双腔管以压迫肺损伤部位并保护对侧部位。在初步控制出血后，我们在第7天进行了弹簧圈栓塞术以治疗假性动脉瘤引起的气管阻塞。对近期21例心脏手术期间肺动脉损伤病例的回顾显示，大多数病例发生在CPB撤机期间，表现为咯血，并采用弹簧圈栓塞术治疗。该病例强调了即使在CPB撤机后加强PAC监测的重要性，以及在心脏手术期间怀疑有肺动脉损伤时及时评估和干预的必要性。
