The inadvisability of thoracoscopic lung biopsy on patients with pulmonary hypertension.
The use of video-assisted thoracoscopic surgery (VATS) sometimes leads to additional and unnecessary risks compared with thoracotomy. We report a troubling case of VATS lung biopsy in a 43-year-old woman with mild pulmonary hypertension. A progressive elevation of pulmonary artery pressure (PAP) was noted after the commencement of right unilateral ventilation. When the systolic PAP reached 90 mm Hg (390 min after induction of anesthesia), a massive blood discharge through the chest drain occurred. At repeat thoracotomy, continuous blood spouting was seen from > 10 of the surgical sites. It was supposed that the endoscopic staplers were unable to maintain hemostasis with such a high PAP.
Hasegawa
Seiki
S
Department of Thoracic Surgery, Kyoto University, Japan. seikiha@kuhp.kyoto-u.ac.jp
Isowa
Noritaka
N
Bando
Toru
T
Wada
Hiromi
H
D000328:Adult; D001706:Biopsy / Q000009:adverse effects*; D000075202:Contraindications; D017809:Fatal Outcome; D005260:Female; D006488:Hemostasis, Surgical; D006801:Humans; D006976:Hypertension, Pulmonary / Q000473:pathology* / Q000503:physiopathology; D008168:Lung / Q000473:pathology*; D019106:Postoperative Hemorrhage / Q000503:physiopathology* / Q000601:surgery; D011669:Pulmonary Wedge Pressure / Q000502:physiology*; D012086:Reoperation; D012859:Sjogren's Syndrome / Q000473:pathology* / Q000503:physiopathology; D013528:Surgical Staplers; D020775:Thoracic Surgery, Video-Assisted; D013908:Thoracotomy