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Anesth Analg 2004;99:1280-1282
© 2004 International Anesthesia Research Society
doi: 10.1213/01.ANE.0000134813.38807.61

CARDIOVASCULAR ANESTHESIA

Treatment of Severe Pulmonary Hemorrhage After Cardiopulmonary Bypass by Selective, Temporary Balloon Occlusion

Ulrich R. Döpfmer, MD FRCA, Jan-Peter Braun, MD, Joachim Grosse, MD, Holger Hotz, MD, Katja Duveneck, MD, and Martin B. Schneider, MD PhD

Departments of Anesthesiology, Pediatric Cardiology, and Cardiac Surgery, Charité Hospital, Berlin, Germany

Address correspondence and reprint requests to Ulrich Döpfmer, MD, Lindenstrasse 30, 12589 Berlin, Germany. Address email to doepfmer{at}snafu.de

Severe pulmonary bleeding causes frequent mortality, particularly if this event occurs during separation from extracorporeal circulation during cardiac surgery. We present a new approach to treat this life-threatening complication: temporary balloon occlusion of the pulmonary artery feeding the involved lobe. On attempting to wean a 71-yr-old female patient from cardiopulmonary bypass after aortic valve replacement, she lost more than 2 L of blood through her trachea over approximately 15 min and severe gas embolism into the left atrium was visualized on transesophageal echocardiography. As the bleeding was too vigorous to be localized by fiberoptic bronchoscopy, an interventional cardiologist was consulted. After localizing the affected lobe using fluoroscopy, he inflated a balloon dilating catheter in the lower lobe artery. This effectively stopped the bleeding. Separation from extracorporeal circulation was uneventful using one-lung ventilation to prevent further gas embolism. Sixteen hours after the end of surgery the catheter could be deflated and removed without any further intervention. The patient made an excellent recovery.

IMPLICATIONS: We report a case of lung bleeding and gas embolization during cardiac surgery that was successfully treated by temporary occlusion of the blood vessel feeding the affected lung lobe with a balloon dilating catheter and temporary selective ventilation of the contralateral lung without further surgical interventions.




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Anesth. Analg., November 1, 2004; 99(5): 1276 - 1279.
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Lippincott, Williams & Wilkins Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999 HighWire Press
Copyright © 2004 by the International Anesthesia Research Society.