肺動脈カテーテルによる術中肺動脈穿孔

Intraoperative Pulmonary Artery Rupture Induced by a Pulmonary Artery Catheter

心臓手術の周術期において肺動脈カテーテル（PAC）による血行動態のモニタリングは有用であるが，肺動脈損傷が生じた場合には致命的になりうる．われわれは，心臓弁膜症手術中にPACにより生じた肺動脈穿孔に対して，体外式膜型人工肺（ECMO）と血管内治療によって救命しえた症例を経験したので報告する．

We herein present a case of massive intratracheal hemorrhage due to pulmonary artery catheter （PAC） use during triple valve surgery. A 75-year-old woman underwent biological aortic valve replacement along with mitral and tricuspid valve annuloplasty. Operative procedures were uneventful. Shortly after weaning from cardiopulmonary bypass, massive blood and froth filled the endotracheal tube. As her blood pressure and arterial oxygen saturation dropped, extracorporeal membrane oxygenation （ECMO） support through the right femoral artery and vein was promptly initiated. After the tip of the PAC was identified in the right pulmonary artery by chest Xray, an endobronchial blocker was used to protect the opposite lung. After clinical stability was achieved, she underwent pulmonary artery angiography and subsequent successful transcatheter embolization. Right heart unloading using ECMO and transcatheter embolization might have played key roles in the management of intraoperative pulmonary artery rupture.