Document Detail


[Management of a catheter-induced rupture of a pulmonary artery].
MedLine Citation:
PMID:  20859841     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
HISTORY AND ADMISSION FINDINGS: A 72-year-old woman presented with progressive dyspnea on exertion. There was no chest pain. A 4/6 systolic murmur was detected on auscultation. INVESTIGATIONS: Echocardiography demonstrated a combined aortic valve defect with severe stenosis and moderate insufficiency, additionally a persistent foramen ovale. The coronary angiography revealed coronary heart disease with severe stenosis of the left anterior descending (LAD) and the right coronary artery (RCA). The stenosis of the aortic valve was severe (Pmax 91 mm Hg, Pmean 52 mm Hg). During catheterization of the right heart iatrogenic perforation of a pulmonary artery occurred, resulting in diffuse pulmonary bleeding. The patient suffered from progredient dyspnea and hemoptysis. DIAGNOSIS, TREATMENT AND COURSE: Catheter-induced rupture of an artery of the right inferior pulmonary lobe was diagnosed. Because of bleeding into this lobe an immediate intubation with a double-lumen bronchial tube was necessary to ensure ventilation of the contralateral lung. Several attempts to occlude the arterial leak by ballon failed. Bleeding stopped after embolisation of the vessel by injection of thrombin. CONCLUSION: Iatrogenic rupture of a pulmonary artery is a rare and life-threatening complication of the catheterization of the right heart and demands rapid therapy. The protection of the contralateral lung by intubation with a double-lumen tubes is of highest priority. Selective embolization of the affected vessel via thrombin can be a lifesaving alternative to lobectomy or conservative therapy.
Authors:
C Damm; H Degen; C Stoepel; M Haude
Publication Detail:
Type:  Case Reports; English Abstract; Journal Article     Date:  2010-09-21
Journal Detail:
Title:  Deutsche medizinische Wochenschrift (1946)     Volume:  135     ISSN:  1439-4413     ISO Abbreviation:  Dtsch. Med. Wochenschr.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-22     Completed Date:  2010-10-14     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0006723     Medline TA:  Dtsch Med Wochenschr     Country:  Germany    
Other Details:
Languages:  ger     Pagination:  1914-7     Citation Subset:  IM    
Copyright Information:
© Georg Thieme Verlag KG Stuttgart · New York.
Affiliation:
Medizinische Klinik I, Lukas Krankenhaus Neuss.
Vernacular Title:
Vorgehen bei einer katheterinduzierten Pulmonalarterienperforation.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aortic Valve Insufficiency / radiography,  surgery*
Aortic Valve Stenosis / radiography,  surgery*
Catheterization, Swan-Ganz / adverse effects*,  instrumentation*
Embolization, Therapeutic / instrumentation,  methods*
Female
Heart Catheterization / adverse effects*,  instrumentation*
Hemorrhage / etiology*,  radiography,  therapy
Humans
Injections, Intra-Arterial
Intraoperative Complications / radiography,  therapy*
Middle Aged
Pulmonary Artery / injuries*,  radiography
Thrombin / administration & dosage*
Chemical
Reg. No./Substance:
EC 3.4.21.5/Thrombin

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


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