Document Detail


Management of catheter-induced pulmonary artery perforation: a rare complication in cardiovascular operations.
MedLine Citation:
PMID:  11789793     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Pulmonary artery perforation is a rare but often fatal complication of the pulmonary artery catheter occurring in cardiovascular operations and at catheterization facilities. We used our experience and a review of the literature to formulate diagnostic and management strategies. METHODS: During a 13-year period, 12 patients with pulmonary artery perforations were treated in a center that performed an average of 860 open-heart procedures per year. Clinical presentation varied from minor hemoptysis to major airway hemorrhage, hypoxia, exsanguination, and cardiac arrest. Airway bleeding occurred shortly after weaning from cardiopulmonary bypass in 5 patients or postoperatively after wedging the catheter in 6. One patient developed a hemothorax and had a cardiac arrest. Treatment included assurance of gas exchange, endobronchial lavage, isolation of the bleeding bronchus and control of hemorrhage by conservative therapy, pulmonary resection, pulmonary artery repair, and arterial embolization. RESULTS: Five of the 12 patients died (42%). Recurrent hemorrhage occurred in 40% of patients (2 of 5) treated conservatively compared with none of the patients (0 of 7) having surgical treatment. Forty three percent of patients (3 of 7) treated surgically died; 20% of patients (1 of 5) treated conservatively died. One patient succumbed without treatment. CONCLUSIONS: Pulmonary artery perforation is a rare and often fatal complication of pulmonary artery catheterization. This was apparent with patients who had airway hemorrhages as a result of weaning from cardiopulmonary bypass or after balloon inflation. Recurrent and fatal hemorrhage was frequent in patients treated by conservative therapy alone. Surgical intervention was effective in control of hemorrhage but did not reduce the number of deaths. Treatment remains highly individualized. It is advisable to be cautious in inserting Swan-Ganz catheters and to avoid their use unless absolutely necessary.
Authors:
S Sirivella; I Gielchinsky; V Parsonnet
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  72     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2001 Dec 
Date Detail:
Created Date:  2002-01-14     Completed Date:  2002-01-31     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2056-9     Citation Subset:  AIM; IM    
Affiliation:
Department of Cardiovascular and Thoracic Surgery, Newark Beth Israel Medical Center, New Jersey, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Catheterization, Swan-Ganz / adverse effects*
Cause of Death
Female
Humans
Iatrogenic Disease
Male
Middle Aged
New Jersey
Postoperative Complications / mortality,  therapy*
Postoperative Hemorrhage / mortality,  therapy
Pulmonary Artery / injuries*,  surgery
Retrospective Studies
Comments/Corrections
Comment In:
Ann Thorac Surg. 2003 Feb;75(2):639; author reply 640   [PMID:  12607704 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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