Difficulty in Weaning from Cardio-Pulmonary Bypass due to Pulmonary Artery Extrinsic Stenosis Caused by a Hematoma―a Case of Ruptured Aortic Arch Aneurysm

Shinji Abe＊	Yasuhiro Kamikubo＊	Ryo Matsumoto＊
Makoto Takahira＊

（Department of Cardiovascular Surgery, Kushiro-City General Hospital＊, Kushiro, Japan）

During aortic arch replacement in response to an aortic arch aneurysm sealed rupture, we experienced a case in which weaning from cardio-pulmonary bypass（CPB）became difficult, and pulmonary artery stenosis developed due to expanded hematoma. A 77-year-old man was raced to our hospital due to subjective symptom of chest/back pain. With a recognition of aortic arch aneurysm and hematoma around the aneurysm, it was diagnosed as an aortic arch aneurysm sealed rupture. Even though an elective aortic arch replacement was implemented using an open stent graft, reduction in blood pressure and poor oxygenation was observed at the process of CPB weaning. As a result of intraoperative pulmonary arteriography, severe stenosis was revealed on both left and right pulmonary arteries. With placement of a self-expanding stent, weaning from CPB was successfully completed. Being transferred to other hospital on day 60 after the surgery in order to continue rehabilitation, the man visits our hospital as an outpatient on his own as of now. As it is considered to be a rare case that weaning from CPB was successfully performed by pulmonary stenting in response to progressed intraoperative pulmonary artery stenosis caused by expanded hematoma after heparin administration, the details are reported here.

 

Jpn. J. Cardiovasc. Surg. 49:295-299（2020）

Keywords：aortic arch aneurysm;cardio-pulmonary bypass;pulmonary artery stenosis;pulmonary artery stenting