A Case of Huge Aortic Arch Aneurysm with Unrevealed Aortopulmonary Fistula Resulting Intraoperative Pulmonary Artery Rupture after Total Arch Replacement
10.4326/jjcvs.33.403
- VernacularTitle:弓部大動脈人工血管置換術施行後に術中肺動脈破裂をきたした大動脈りゅう肺動脈穿通の１治験例
- Author:
Masato Yoshida
;
Nobuhiko Mukohara
;
Hidefumi Obo
;
Keitaro Nakagiri
;
Hiroya Minami
;
Tomoki Hanada
;
Ayako Maruo
;
Hironori Matsuhisa
;
Naoto Morimoto
;
Tsutomu Shida
- Publication Type:Journal Article
- From:Japanese Journal of Cardiovascular Surgery
2004;33(6):403-406
- CountryJapan
- Language:Japanese
-
Abstract:
A 70-year-old-woman was admmitted to receive an operation for aortic arch aneurysm. Total arch replacement was carried out under deep hypothermic circuratory arrest with selective cerebral perfusion. During sternal closure, her blood pressure dropped to 60/30mmHg suddenly, and massive venous bleeding started from the substernal space which turned out to be hemorrhage from the laceration of the pulmonary trunk. Controlling the bleeding by finger compression, rapid introduction of cardiopulmonary bypass was carried out and the laceration was closed by a pericardial patch. The postoperative course was uneventful. In this case, compression of the pulmonary trunk by the aortic arch aneurysm may have caused the fistula formation between them, and decompression of the aneurysm probably induced the rupture of the pulmonary trunk. If the preoperative computed tomogram had showed the compression of the pulmonary artery by the aneurysm, a careful exploration of the main pulmonary artery and a removal of the thrombus should have been performed, even when the preoperative diagnostic evaluation failed to reveal aortopulmonary fistula.
