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Catheter Induced PA Perforation

Catheter Induced PA Perforation. Case II. 55 female non smoker POD#7 CABG & mitral valve annuloplasty Chest medicine consult because of Recurrent hemoptysis No previous hemoptysis. History. Initial presentation of NSTEMI & CHF NO fever , CP , leg pain or SOB

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Catheter Induced PA Perforation

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  1. Catheter Induced PA Perforation

  2. Case II • 55 female non smoker • POD#7 CABG & mitral valve annuloplasty • Chest medicine consult because of Recurrent hemoptysis • No previous hemoptysis

  3. History • Initial presentation of NSTEMI & CHF • NO fever , CP , leg pain or SOB • POD#1 frank blood from ETT without hemodynamic consequence Coagulopathy corrected INR 1.5 & Plt 70 • POD#3 thick clotted blood

  4. History • PMH No CAP , TB • No travel , contact , pets • No occupational risk • Rx : ASA , Metoprolol , Ramipril

  5. Examination • Stable RR 14 Sat 91% RA 96% 3 l O2 BP 120/80 HR 70 afebrile • Chest : decreased BS anteriorly • CVS : S1+S2+O • Abd & LL  NAD

  6. Investigation • WBC 11 HB 70  55  70 POD#1 No further drop • Renal function N • Minimal sputum for study • CXR & CT chest

  7. Course • Bronchoscopy  N airway Thick blood clot LUL

  8. Catheter Induced PA Perforation • Injury can be intimal tear full thickness rupture retrograde dissection contralateral pulmonary artery • As result pulmonary hemorrhage and hematomas extend into the airways rupture through visceral pleura hemothorax • The parenchymal hemorrhage self-limited if a defect in the arterial wall seals or forms a pulmonary artery pseudoaneurysm  high potential for rupture Ann Of thoracic Sx 2001

  9. Catheter Induced PA Perforation • Retrospective study 1985-1998 • 850 Swan Ganz line Cardiac Sx CABG , Valve , Aortic Aneurysm • 12 case of perforation 0.1% • Mean age 70 Female : Male 2:1 Ann Of thoracic Sx 2001

  10. Catheter Induced PA Perforation Intraoperative Dx 5 cases  Brisk blood from ETT during weaning CPB or immediately after Postoperative Dx 7 cases 3 Pts  brisk blood ETT with inflating balloon 1 Pt  Cardiac arrest discovered during chest exploration 3 Pts  Mild hemoptysis Ann Of thoracic Sx 2001

  11. Catheter Induced PA Perforation • Brisk Blood ETT (300-400) was managed with Bronchial blocker in 6 Pts with Double lumen ETT in 2 Pts • Intraoperative cases All had injury to branches of lobar artery 1 in addition had injury to Lt main 3 lobectomies & 1 pneumonectomy Ann Of thoracic Sx 2001

  12. Catheter Induced PA Perforation • 2 postop major bleeding Initially stable 1 died of extensive lobar hemorrhage • 3 postop minor hemoptysis 1 complete recovery 1 died after recurrent hemoptysis from rupture pesudoaneurysm POD#15 1 recurrent hemoptysis  embolization Ann Of thoracic Sx 2001

  13. Catheter Induced PA Perforation • 73% of injuries were Rt sided mainly lobar artery branches • RLL 43% > RML 27% > RUL 7% • Mortality 42% Higher in old age , female & in surgically treated group Ann Of thoracic Sx 2001

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