Pulmonary artery rupture during cardiopulmonary bypass

Abstract

B ALLOON-TIPPED flotation catheters are commonly used in the perioperative management of cardiac surgical patients. Pulmonary artery rupture is a rare but often fatal complication. The majority of pulmonary artery perforations associated with the use of these catheters have occurred in the perioperative period of cardiac surgical patients. 1'2 In a prospective study by Shah et al 2 involving over 6,000 patients, intrapulmonary hemorrhage occurred in four (0.064%) patients. Three of the four patients were anticoagulated and on cardiopulmonary bypass. Of the four patients who suffered this complication, one (25%) died. The overall mortality rate in their series for all patients with pulmonary artery catheters was 0.016%. McDaniel 3 reported three out of 1,500 patients (0.2%) with catheter-induced pulmonary artery rupture. All three patients were anticoagulated. Hannan et al 4 reviewed 28 case reports of catheter-induced pulmonary artery rupture and reported a mortality rate of 75% in anticoagulated patients with an overall mortality rate of 46%. Although the incidence of pulmonary artery rupture is low, the mortality is high especially in anticoagulated patients. Prompt diagnosis and treatment are essential for patient survival. This is a report of a case of perforation of a pulmonary artery in an anticoagulated cardiac surgical patient before coming off cardiopulmonary bypass, which necessitated an emergency right middle lobectomy. The diagnosis, treatment, and prevention of pulmonary artery rupture as a result of pulmonary artery catheterization are also discussed.