[Postoperative pulmonary bleeding and reperfusion pulmonary edema in an adult patient after repair of tetralogy of Fallot with pulmonary atresia--percutaneous cardiopulmonary support (PCPS) and lung protective ventilatory strategy].
After total correction of tetralogy of Fallot, pulmonary atresia and major aorto-pulmonary collateral arteries, a 31-year-old man developed life-threatening pulmonary hypertension and reperfusion pulmonary edema, leading to pulmonary hemorrhage, right heart failure and hypoxia. Because of difficulty in weaning from cardiopulmonary bypass and in controlling hemorrhage from pulmonary arteries, we applied percutaneous cardiopulmonary support (PCPS) for 281 hours with strategy of delayed sternal closure (17 days) and a large quantity of transfusion. We also applied lung protective ventilatory strategy for reperfusion pulmonary edema (high PEEP, limited peak inspiratory pressure and recruitment maneuver). As the result, he was discharged alive without any major complications. We report our postoperative managements, in terms of 1) lung protective ventilatory strategy, 2) surgical control of pulmonary blood flow, and 3) evaluation of the cardiopulmonary function during PCPS for early weaning from PCPS.
Takauchi
Yuji
Y
Department of Surgical Intensive Care Unit, National Cardiovascular Center, Suita 565-8565.
Imanaka
Hideaki
H
Takeuchi
Muneyuki
M
Tachibana
Kazuya
K
D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods*; D006470:Hemorrhage / Q000628:therapy*; D006801:Humans; D008171:Lung Diseases / Q000628:therapy*; D008297:Male; D011183:Postoperative Complications / Q000628:therapy*; D018633:Pulmonary Atresia / Q000150:complications / Q000601:surgery*; D011654:Pulmonary Edema / Q000628:therapy*; D012121:Respiration, Artificial / Q000379:methods*; D013771:Tetralogy of Fallot / Q000150:complications / Q000601:surgery*; D016896:Treatment Outcome