[Management of a catheter-induced rupture of a pulmonary artery]. / Vorgehen bei einer katheterinduzierten Pulmonalarterienperforation.
Dtsch Med Wochenschr
; 135(39): 1914-7, 2010 Oct.
Article
em De
| MEDLINE
| ID: mdl-20859841
ABSTRACT
HISTORY AND ADMISSION FINDINGS:
A 72-year-old woman presented with progressive dyspnea on exertion. There was no chest pain. A 4/6 systolic murmur was detected on auscultation. INVESTIGATIONS Echocardiography demonstrated a combined aortic valve defect with severe stenosis and moderate insufficiency, additionally a persistent foramen ovale. The coronary angiography revealed coronary heart disease with severe stenosis of the left anterior descending (LAD) and the right coronary artery (RCA). The stenosis of the aortic valve was severe (Pmax 91 mm Hg, Pmean 52 mm Hg). During catheterization of the right heart iatrogenic perforation of a pulmonary artery occurred, resulting in diffuse pulmonary bleeding. The patient suffered from progredient dyspnea and hemoptysis. DIAGNOSIS, TREATMENT AND COURSE Catheter-induced rupture of an artery of the right inferior pulmonary lobe was diagnosed. Because of bleeding into this lobe an immediate intubation with a double-lumen bronchial tube was necessary to ensure ventilation of the contralateral lung. Several attempts to occlude the arterial leak by ballon failed. Bleeding stopped after embolisation of the vessel by injection of thrombin.CONCLUSION:
Iatrogenic rupture of a pulmonary artery is a rare and life-threatening complication of the catheterization of the right heart and demands rapid therapy. The protection of the contralateral lung by intubation with a double-lumen tubes is of highest priority. Selective embolization of the affected vessel via thrombin can be a lifesaving alternative to lobectomy or conservative therapy.
Texto completo:
1
Base de dados:
MEDLINE
Assunto principal:
Insuficiência da Valva Aórtica
/
Estenose da Valva Aórtica
/
Artéria Pulmonar
/
Cateterismo de Swan-Ganz
/
Cateterismo Cardíaco
/
Trombina
/
Embolização Terapêutica
/
Hemorragia
/
Complicações Intraoperatórias
Idioma:
De
Ano de publicação:
2010
Tipo de documento:
Article