Postoperative Bleeding from the Right Lung after Aortic Root Replacement Treated Successfully with ECMO in a Patient Who Underwent Radical Operation for Tetralogy of Fallot 38 Years Ago

(Department of Surgery and Department of Cardiova-scular Surgery*, Teikyo University, Tokyo, Japan)

Yasuhiko Kobayashi Masataka Mitsuno Mitsuhiro Yamamura
Hiroe Tanaka Masaaki Ryomoto Hiroyuki Nishi
Shinya Fukui Noriko Tsujiya
Tetsuya Kajiyama , Yuji Miyamoto
We successfully performed aortic root replacement in an asymptomatic 52 year-old man with dilatation of the Valsalva sinuses(75mm). The patient had previously undergone a radical operation for the tetralogy of Fallot at 13 years of age and AVR at 46 years of age. Massive bleeding occurred in the lungs after weaning from CPB. Emergency bronchoscopy revealed that the bleeding came from the right middle and lower lobes. The bleeding was stopped conservatively on POD 3;however, V-V ECMO was started on POD 5 because of severe hypoxia. ECMO was successfully weaned on POD 11 and he discharged on POD 59. The presence of developed bronchial collaterals and barotrauma during the operation were speculated the causes of the bleeding from the right lung.
  Jpn. J. Cardiovasc. Surg. 38:75-78(2009)