title: The inadvisability of thoracoscopic lung biopsy on patients with pulmonary hypertension.
abstract: 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.
authors.affiliation: Department of Thoracic Surgery, Kyoto University, Japan. seikiha@kuhp.kyoto-u.ac.jp
authors.forename: Seiki
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Noritaka
authors.initials: N
authors.lastname: Isowa
authors.forename: Toru
authors.initials: T
authors.lastname: Bando
authors.forename: Hiromi
authors.initials: H
authors.lastname: Wada
mesh_terms: 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