Pulmonary artery laceration by a pulmonary artery catheter: a case report and review of the literature.
A 74-year-old white man with unstable angina underwent an uneventful urgent four-vessel coronary bypass operation at which time a Tenkhoff catheter was placed because of renal insufficiency. Two hours following arrival in the intensive care unit, the patient demonstrated hemodynamic instability, progressive acidosis, and a fall in his hematocrit from 35% to 18%. In retrospect, this instability was initiated by wedging of the pulmonary artery catheter. Hemorrhagic complications involving the use of flow-directed, balloon-tipped catheters are rare following cardiopulmonary bypass operations. The estimated incidence is reported at 1 to 2 per 1,000, although many may go unreported. The mortality rate is in excess of 50%. We report a case of a successfully repaired laceration of the pulmonary artery caused by a pulmonary artery catheter following cardiac surgery, and provide a review of the literature. As illustrated by this case and emphasized in the literature, salvage of patients who suffer this complication requires a high index of suspicion in order to rapidly recognize the injury and intervene with the appropriate therapy.
Bolton
J W
JW
Department of Cardiothoracic Surgery, Wilford Hall USAF Medical Center/PSST, 2200 Berquist Drive, Suite 1, Lackland Air Force Base, TX 78236-5300, USA.
Aldea
G S
GS
D000140:Acidosis, Lactic; D000368:Aged; D006328:Cardiac Catheterization / Q000009:adverse effects*; D001026:Coronary Artery Bypass; D006439:Hemodynamics; D006470:Hemorrhage / Q000209:etiology; D006801:Humans; D015994:Incidence; D022125:Lacerations / Q000175:diagnosis / Q000209:etiology*; D008297:Male; D011651:Pulmonary Artery / Q000293:injuries*