Treatment of severe pulmonary hemorrhage after cardiopulmonary bypass by selective, temporary balloon occlusion.
Severe pulmonary bleeding causes frequent mortality, particularly if this event occurs during separation from extracorporeal circulation during cardiac surgery. We present a new approach to treat this life-threatening complication: temporary balloon occlusion of the pulmonary artery feeding the involved lobe. On attempting to wean a 71-yr-old female patient from cardiopulmonary bypass after aortic valve replacement, she lost more than 2 L of blood through her trachea over approximately 15 min and severe gas embolism into the left atrium was visualized on transesophageal echocardiography. As the bleeding was too vigorous to be localized by fiberoptic bronchoscopy, an interventional cardiologist was consulted. After localizing the affected lobe using fluoroscopy, he inflated a balloon dilating catheter in the lower lobe artery. This effectively stopped the bleeding. Separation from extracorporeal circulation was uneventful using one-lung ventilation to prevent further gas embolism. Sixteen hours after the end of surgery the catheter could be deflated and removed without any further intervention. The patient made an excellent recovery.
Döpfmer
Ulrich R
UR
Departments of Anesthesiology, Pediatric Cardiology, and Cardiac Surgery, Charité Hospital, Berlin, Germany.
Braun
Jan-Peter
JP
Grosse
Joachim
J
Hotz
Holger
H
Duveneck
Katja
K
Schneider
Martin B
MB
D021721:Balloon Occlusion; D002315:Cardiopulmonary Bypass / Q000009:adverse effects*; D017548:Echocardiography, Transesophageal; D004618:Embolism, Air / Q000000981:diagnostic imaging / Q000517:prevention & control; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008171:Lung Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D008875:Middle Aged; D019106:Postoperative Hemorrhage / Q000000981:diagnostic imaging / Q000628:therapy*; D012121:Respiration, Artificial; D014057:Tomography, X-Ray Computed