術中肺動脈カテーテル穿孔による気管内大量出血に対し保存的治療が奏功した大動脈弁手術の1例

Pulmonary Artery Catheter-induced Massive Tracheal Hemorrhage during Aortic Valve Surgery；Report of a Case

はじめに　肺動脈カテーテル（PAC）は心臓手術周術期の循環動態管理に有用であるが，術中にカテーテルによる肺動脈損傷が生じた場合，致命的な合併症となりうる．われわれは，大動脈弁置換術（AVR）と肺静脈隔離術（PVI）中にPACによる肺動脈穿孔が原因と考えられる気管内大量出血をきたしたが，保存的治療を遂行して肺切除にいたらず救命しえた貴重な症例を経験したので報告する．

We report a case of pulmonary artery catheter （PAC）-induced massive intratracheal hemorrhage during aortic valve surgery. An 81-year-old woman underwent aortic valve replacement and pulmonary vein isolation. Operative procedures were uneventful, but active and massive intratracheal hemorrhage started just after cardiopulmonary bypass was discontinued. We immediately resumed cardiopulmonary bypass and replaced the endotracheal tube with a double-lumen one, keeping the airway pressure high（20 cmH2O）. Those maneuvers reduced intratracheal hemorrhage and maintained oxygenation, and then cardiopulmonary bypass was disconnected without lung lobectomy. Mechanical ventilation with high positive end expiratory pressure for 6 days in the intensive care unit let her good recovery. A postoperative enhanced computed tomography revealed a thrombosed right pulmonary artery pseudoaneurysm possibly induced by PAC. After close observation the patient left the hospital on foot.