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Titolo:
Management of catheter-induced pulmonary artery perforation: A rare complication in cardiovascular operations
Autore:
Sirivella, S; Gielchinsky, I; Parsonnet, V;
Indirizzi:
Newark Beth Israel Med Ctr, Dept Thorac & Cardiovasc Surg, Newark, NJ USA Newark Beth Israel Med Ctr Newark NJ USA Cardiovasc Surg, Newark, NJ USA
Titolo Testata:
ANNALS OF THORACIC SURGERY
fascicolo: 6, volume: 72, anno: 2001,
pagine: 2056 - 2059
SICI:
0003-4975(200112)72:6<2056:MOCPAP>2.0.ZU;2-4
Fonte:
ISI
Lingua:
ENG
Soggetto:
HEMORRHAGE; RUPTURE; HEMOPTYSIS; DIAGNOSIS;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
19
Recensione:
Indirizzi per estratti:
Indirizzo: Gielchinsky, I 343 Forest Rd, S Orange, NJ 07079 USA 343 Forest Rd S Orange NJ USA 07079 S Orange, NJ 07079 USA
Citazione:
S. Sirivella et al., "Management of catheter-induced pulmonary artery perforation: A rare complication in cardiovascular operations", ANN THORAC, 72(6), 2001, pp. 2056-2059

Abstract

Background. Pulmonary artery perforation is a rare but often fatal complication of the pulmonary artery catheter occurring in cardiovascular operations and at catheterization facilities. We used our experience and a review of the literature to formulate diagnostic and management strategies. Methods. During a 13-year period, 12 patients with pulmonary artery perforations were treated in a center that performed an average of 860 open-heartprocedures per year. Clinical presentation varied from minor hemoptysis tomajor airway hemorrhage, hypoxia, exsanguination, and cardiac arrest. Airway bleeding occurred shortly after weaning from cardiopulmonary bypass in 5patients or postoperatively after wedging the catheter in 6. One patient developed a hemothorax and had a cardiac arrest. Treatment included assurance of gas exchange, endobronchial lavage, isolation of the bleeding bronchusand control of hemorrhage by conservative therapy, pulmonary resection, pulmonary artery repair, and arterial embolization. Results. Five of the 12 patients died (42%). Recurrent hemorrhage occurredin 40% of patients (2 of 5) treated conservatively compared with none of the patients (0 of 7) having surgical treatment. Forty three percent of patients (3 of 7) treated surgically died; 20% of patients (1 of 5) treated conservatively died. One patient succumbed without treatment. Conclusions. Pulmonary artery perforation is a rare and often fatal complication of pulmonary artery catheterization. This was apparent with patientswho had airway hemorrhages as a result of weaning from cardiopulmonary bypass or after balloon inflation. Recurrent and fatal hemorrhage was frequentin patients treated by conservative therapy alone. Surgical intervention was effective in control of hemorrhage but did not reduce the number of deaths. Treatment remains highly individualized. It is advisable to be cautiousin inserting Swan-Ganz catheters and to avoid their use unless absolutely necessary. (C) 2001 by The Society of Thoracic Surgeons.

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Documento generato il 04/07/20 alle ore 18:29:18