title: [Case of pulmonary hemorrhage suspected to be caused by pulmonary artery catheter after cardiac surgery].
abstract: We report a case of pulmonary hemorrhage suspected to be caused by a pulmonary artery catheter (PAC) after cardiac surgery. An 80-year-old woman underwent aortic valve replacement, mitral valve replacement, and tricuspid annuloplasty. After anesthesia induction, a PAC was inserted from the right jugular vein and fixed at 48 cm, but it could not be wedged. Therefore, the PAC was fixed at 59 cm to measure the pulmonary capillary wedge pressure during the operation. The catheter showed a postoperative bending. The chest X-ray radiograph obtained at the first postoperative day showed a shadow in the right middle and lower lung. PAC was pulled and fixed at 48 cm, but the shadow continued to grow in size. A large volume of bloody drainage fluid was obtained. Therefore, we operated again. No bleeding or hematoma was observed in the mediastinum or pericardium. However, a hematoma spreading from the hilum of the right lung was observed under the visceral pleura. The patient was discharged on the 23rd postoperative day. The lung hemorrhage may have been caused by PAC-induced pulmonary artery injury since no lung injury was observed during reoperation. Therefore, care should be taken to prevent pulmonary artery injury by excessively deep insertion of PAC.
authors.affiliation: Department of Anesthesiology, Osaka Rosoai Hospital, Sakai 591-8025.
authors.forename: Shunsuke
authors.initials: S
authors.lastname: Yamamoto
authors.forename: Mitsuhide
authors.initials: M
authors.lastname: Yabe
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujii
authors.forename: Yoko
authors.initials: Y
authors.lastname: Yamamoto
authors.forename: Takekazu
authors.initials: T
authors.lastname: Terai
mesh_terms: D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures; D002407:Catheterization, Swan-Ganz / Q000009:adverse effects*; D005260:Female; D006331:Heart Diseases / Q000601:surgery*; D006470:Hemorrhage / Q000209:etiology* / Q000628:therapy; D006801:Humans; D008171:Lung Diseases / Q000209:etiology* / Q000628:therapy; D011183:Postoperative Complications / Q000209:etiology*; D011651:Pulmonary Artery / Q000293:injuries*; D016896:Treatment Outcome