開心術中の大量肺出血に対するEndobronchial Watanabe Spigotによる気管支充塡術の1例

Bronchial Occlusion with Endobronchial Watanabe Spigot for Massive Pulmonary Hemorrhage during Heart Surgery；Report of a Case

はじめに　開心術中の大量肺出血はまれではあるが致死的となりうる病態で，適切かつ迅速な治療を要する．Endobronchial Watanabe Spigot （EWS）による気管支充塡術は難治性気胸，気管支瘻に対する治療法である1）が，気道内出血に対する治療としてもその有用性が報告2）されている．われわれは体外循環離脱後の大量肺出血に対してEWSによる気管支充塡術により救命できた1例を経験したので報告する．

Massive pulmonary hemorrhage, although rare, is a potentially life-threatening complications during heart surgery. We herein present 1 such case successfully treated by selective bronchial occlusion using an Endobronchial Watanabe Spigot （EWS）. The 82-year-old female underwent mitral valve replacement, tricuspid annuloplasty, and maze procedure. An hour and a half after cessation of cardiopulmonary bypass, the patient suffered a massive pulmonary hemorrhage. A subsequent bronchoscopy identified the hemorrhage site at the right middle lobe bronchus （B5b）， and an EWS was then selectively deployed into this bronchus to block the hemorrhage.

The following day, bronchial arterial embolization was performed, enabling the removal of the spigot on the next day. The patient’s respiratory condition gradually improved, allowing for extubation on the 21st postoperative day. By preventing bleeding into neighboring bronchi, which, in turn, avoids the risk of exacerbating hypoxia, bronchial occlusion with EWSs is highly effective in managing massive pulmonary hemorrhage during heart surgery.