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Ann Thorac Surg 1998;66:1242-1245
© 1998 The Society of Thoracic Surgeons
a Department of Cardiothoracic Surgery, The Royal Melbourne Hospital, Melbourne, Australia
b Department of Anaesthesia, The Royal Melbourne Hospital, Melbourne, Australia
c Department of Intensive Care, The Royal Melbourne Hospital, Melbourne, Australia
d Department of Radiology, The Royal Melbourne Hospital, Melbourne, Australia
Accepted for publication April 19, 1998.
Address correspondence to Dr Mullerworth, Royal Melbourne Hospital, Melbourne, PO Box 2148, 3050, Australia
Background. Catheter-induced pulmonary artery rupture is a well-recognized complication of invasive monitoring, but the risk has not diminished. Although commonly associated with cardiopulmonary bypass, injuries also occur in intensive care. Definitive proof requires pulmonary angiography or autopsy. Many cases are never reported, and lesser injuries are probably underdiagnosed.
Methods. Seven cases fulfilling accepted diagnostic criteria discovered over 2 years are described in four groups illustrating the common modes of presentation: hemoptysis with hypoxemia, exsanguination, delayed recurrent hemorrhage, and bleeding with cardiopulmonary bypass.
Results. One patient had a planned elective operation deferred. Four patients were being monitored in intensive care. Two of them died of pulmonary artery rupture. Two other patients had bleeding on weaning from cardiopulmonary bypass. One settled with conservative treatment, the other survived after extracorporeal life support. Recognition and management are discussed, emphasizing means of avoiding pulmonary resection.
Conclusions. Catheter-induced pulmonary artery rupture is unavoidable. Constant awareness is essential. A plan of management is presented. Extracorporeal life support may help to avoid pulmonary resection. Early pulmonary angiography is advocated for accurate diagnosis and to enable treatment by embolization.
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