[Management of a catheter-induced rupture of a pulmonary artery].
METHODS
A 72-year-old woman presented with progressive dyspnea on exertion. There was no chest pain. A 4/6 systolic murmur was detected on auscultation.


METHODS
Echocardiography demonstrated a combined aortic valve defect with severe stenosis and moderate insufficiency, additionally a persistent foramen ovale. The coronary angiography revealed coronary heart disease with severe stenosis of the left anterior descending (LAD) and the right coronary artery (RCA). The stenosis of the aortic valve was severe (Pmax 91 mm Hg, Pmean 52 mm Hg). During catheterization of the right heart iatrogenic perforation of a pulmonary artery occurred, resulting in diffuse pulmonary bleeding. The patient suffered from progredient dyspnea and hemoptysis.


METHODS
Catheter-induced rupture of an artery of the right inferior pulmonary lobe was diagnosed. Because of bleeding into this lobe an immediate intubation with a double-lumen bronchial tube was necessary to ensure ventilation of the contralateral lung. Several attempts to occlude the arterial leak by ballon failed. Bleeding stopped after embolisation of the vessel by injection of thrombin.


CONCLUSIONS
Iatrogenic rupture of a pulmonary artery is a rare and life-threatening complication of the catheterization of the right heart and demands rapid therapy. The protection of the contralateral lung by intubation with a double-lumen tubes is of highest priority. Selective embolization of the affected vessel via thrombin can be a lifesaving alternative to lobectomy or conservative therapy.
Damm
C
C
Medizinische Klinik I, Lukas Krankenhaus Neuss.
Degen
H
H
Stoepel
C
C
Haude
M
M
D000368:Aged; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000601:surgery*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation*; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects* / Q000295:instrumentation*; D004621:Embolization, Therapeutic / Q000295:instrumentation / Q000379:methods*; D005260:Female; D006470:Hemorrhage / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D006801:Humans; D007269:Injections, Intra-Arterial; D007431:Intraoperative Complications / Q000000981:diagnostic imaging / Q000628:therapy*; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000293:injuries*; D011859:Radiography; D013917:Thrombin / Q000008:administration & dosage*
D013917:Thrombin