A Case of Successful Hemostasis for Intraoperative Massive Endobronchial Hemorrhage after Mitral and Tricuspid Surgery

A Case of Successful Hemostasis for Intraoperative Massive Endobronchial Hemorrhage after Mitral and Tricuspid Surgery

（Department of Cardiothoracic Surgery, Niigata Prefectural Shibata Hospital, Shibata, Japan）

Osamu Namura Koji Shimada Hajime Ohzeki

A 79-year-old woman with degenerative mitral regurgitation and secondary tricuspid regurgitation underwent mitral and tricuspid repair. Massive and intractable endobronchial hemorrhage occurred during weaning from cardiopulmonary bypass（CPB). Bronchoscopic examination during CPB revealed that the right distal bronchus was the probable bleeding point. We then performed a double-lumen endotracheal tube and a bronchial blocker in the distal portion of the right main bronchus. In addition, extracorporeal membrane oxygenation（ECMO）with a heparin-coating system was performed for 11 h, without extra heparinization because of severe hypoxia. The bronchial blocker was removed 14 h later, and the patient was weaned from ECMO 19 h after admission into ICU. Postoperative computed tomography（CT）revealed a pseudoaneurysm of the right pulmonary artery（A⁵b）corresponding with the probable site of bronchial bleeding（B⁵). We speculate that a pulmonary artery catheter induced this endobronchial hemorrhage. At 3 months after surgery the patient was doing well with no symptoms of airway bleeding, and her abnormal CT findings had disappeared.
Jpn. J. Cardiovasc. Surg. 39:276-280（2010）

Keywords：endobronchial hemorrhage, cardiopulmonary bypass, pulmonary artery catheter, bronchial tamponade, ECMO