RECOGNITION AND MANAGEMENT OF CATHETER-INDUCED PULMONARY-ARTERY RUPTURE

Background. Catheter-induced pulmonary artery rupture is a well-recogn ized complication of invasive monitoring, but the risk has not diminis hed. Although commonly associated with cardiopulmonary bypass, injurie s also occur in intensive care. Definitive proof requires pulmonary an giography or autopsy. Many cases are never reported, and lesser injuri es are probably underdiagnosed. Methods. Seven cases fulfilling accept ed diagnostic criteria discovered over 2 years are described in four g roups illustrating the common modes of presentation: hemoptysis with h ypoxemia, exsanguination, delayed recurrent hemorrhage, and bleeding w ith cardiopulmonary bypass. Results. One patient had a planned electiv e 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 o f avoiding pulmonary resection. Conclusions. Catheter-induced pulmonar y artery rupture is unavoidable. Constant awareness is essential. A pl an of management is presented. Extracorporeal life support may help to avoid pulmonary resection. Early pulmonary angiography is advocated f or accurate diagnosis and to enable treatment by embolization. (Ann Th orac Surg 1998;66:1242-5) (C) 1998 by The Society of Thoracic Surgeons .