Pulmonary artery rupture by pulmonary artery catheter in cardiac surgery: a case report and review of literature.

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.