A Case of Successful Hemostasis for Intraoperative Massive Endobronchial Hemorrhage after Mitral and Tricuspid Surgery
10.4326/jjcvs.39.276
- VernacularTitle:僧帽弁形成術の人工心肺施行中に発生した大量気道内出血の1救命例
- Author:
Osamu Namura
;
Koji Shimada
;
Hajime Ohzeki
- Publication Type:Journal Article
- Keywords:
endobronchial hemorrhage;
cardiopulmonary bypass;
pulmonary artery catheter;
bronchial tamponade;
ECMO
- From:Japanese Journal of Cardiovascular Surgery
2010;39(5):276-280
- CountryJapan
- Language:Japanese
-
Abstract:
A 79-year-old woman with degenerative mitral regurgitation and secondary tricuspid regurgitation underwent mitral and tricuspid repair. Massive and intractable endobronchial hemorrhage occurred during weaning from cardiopulmonary bypass (CPB). Bronchoscopic examination during CPB revealed that the right distal bronchus was the probable bleeding point. We then performed a double-lumen endotracheal tube and a bronchial blocker in the distal portion of the right main bronchus. In addition, extracorporeal membrane oxygenation (ECMO) with a heparin-coating system was performed for 11 h, without extra heparinization because of severe hypoxia. The bronchial blocker was removed 14 h later, and the patient was weaned from ECMO 19 h after admission into ICU. Postoperative computed tomography (CT) revealed a pseudoaneurysm of the right pulmonary artery (A5b) corresponding with the probable site of bronchial bleeding (B5). We speculate that a pulmonary artery catheter induced this endobronchial hemorrhage. At 3 months after surgery the patient was doing well with no symptoms of airway bleeding, and her abnormal CT findings had disappeared.
