Key result
Coil embolization and CPB resolve massive PAC-induced intratracheal bleeding without requiring pulmonary resection.
Why the study?
Pulmonary artery injury caused by pulmonary artery catheter during cardiac surgery is a rare but life-threatening complication requiring prompt evaluation and intervention.
Case Report (n=1)
PAC-induced pulmonary artery rupture is a rare, life-threatening complication during cardiac surgery that requires prompt recognition, often during CPB weaning, and can be treated with coil embolization.
Alerts to rare PAC rupture risk during aortic surgery; leaves open safer monitoring alternatives pending prospective data.
The pulmonary artery catheter (PAC) is widely used in cardiac surgery for monitoring hemodynamics and cardiovascular function. Complications including pulmonary artery injury causing massive intratracheal hemorrhage are rare but can be life-threatening. We report a case of intratracheal bleeding (3,000 ml) caused by PAC-induced pulmonary artery injury during cardiac surgery and after weaning from cardiopulmonary bypass (CPB). During surgery for acute type A aortic dissection followed by CPB weaning, pulsatile bleeding from the endotracheal tube and desaturation were observed. We reinstituted CPB and placed a right-sided double-lumen tube to compress the injured site of the lung and protect the contralateral site. Following initial bleeding control, we conducted coil embolization to treat tracheal obstruction by a pseudoaneurysm on day 7. A review of 21 recent cases of pulmonary artery injury during cardiac surgery showed that most cases occurred during CPB weaning, manifested hemoptysis, and were treated by coil embolization. This case underscores the importance of enhanced PAC monitoring even after CPB weaning and the need for prompt evaluation and intervention when pulmonary artery injury is suspected during cardiac surgery.
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Nakamura et al. (2025) conducted a case report in Pulmonary artery rupture by pulmonary artery catheter in cardiac surgery (n=1). Comprehensive management including CPB reinstitution, double-lumen tube placement, and coil embolization was evaluated on Hemostasis and resolution of pseudoaneurysm. Massive intratracheal bleeding caused by pulmonary artery catheter-induced injury was successfully managed without pulmonary resection through cardiopulmonary bypass reinstitution, double-lumen tube placement, and coil embolization.
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