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Reokklusion mit Thrombin nach Perforation der peripheren Pulmonalarterie mit Hämorrhagie während Rechtsherzkatheteruntersuchung

Reocclusion with thrombin after perforation of the peripheral pulmonary artery with haemorrhage during right heart catheterization

  • KASUISTIK
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Intensivmedizin und Notfallmedizin

Abstract

We report on the accidental perforation of a pulmonary artery branch during right heart catheterization in an 84-year-old woman undergoing aortic valvuloplasty, and the management of the crisis resulting in full recovery of the patient. The perforation evoked immediate intrapulmonary haemorrhage associated with asphyxia. Its location was rapidly identified and the sequela of the perforation was minimized by repositioning the Swan-Ganz catheter with proximal balloon inflation. General anaesthesia with endotracheal intubation and endobronchial lavage was required. Definite closure of the perforation was achieved by injection of Thrombin (5000 IU) via the distal end of the Swan-Ganz catheter which remained inflated for another 6 h. The patient could be extubated after 12 h and returned to the ward after 48 h. No neurological deficits occurred and no pseudoaneurysm was discovered during follow-up.

Zusammenfassung

Wir berichten über die iatrogene Perforation eines Pulmonalarterienastes bei einer 84-jährigen Patientin nach Aortenklappenvalvuloplastie und das nachfolgende Krisenmanagement mit Restitutio ad integrum. Die Perforation verursachte eine intrapulmonale Hämorrhagie mit drohender Asphyxie. Die Ursache wurde rasch erkannt und die Blutung durch Repositionierung des Swan-Ganz-Katheters mit Balloninsufflation proximal der Perforationsstelle gestoppt, während gleichzeitig eine Narkose mit Intubation und Bronchiallavage eingeleitet wurde. Die Perforationsstelle wurde definitiv durch die Injektion von Thrombin (5000 IE) über den Swan-Ganz-Katheter verschlossen und dessen Ballon in insuffliertem Zustand für sechs Stunden belassen. Die Patientin wurde nach 12 h extubiert und nach 48 h auf die Normalstation verlegt. Es traten keine neurologischen Defizite auf. Im Verlauf bildete sich kein Pseudoaneurysma aus.

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Authors and Affiliations

  1. Universitätsklinikum Essen, Klinik für Kardiologie Westdeutsches Herzzentrum Essen, Hufelandstraße 55, 45122, Essen, Germany

    Stefan Sack, Philipp Kahlert, Sebastian Philipp, Sophia Churzidse, Thomas Konorza & Raimund Erbel

  2. Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Germany

    Eva Kottenberg-Assenmacher & Jürgen Peters

Authors
  1. Stefan Sack
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  2. Philipp Kahlert
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  3. Sebastian Philipp
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  4. Eva Kottenberg-Assenmacher
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  5. Sophia Churzidse
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  6. Thomas Konorza
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  7. Jürgen Peters
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  8. Raimund Erbel
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Correspondence to Stefan Sack.

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Sack, S., Kahlert, P., Philipp, S. et al. Reokklusion mit Thrombin nach Perforation der peripheren Pulmonalarterie mit Hämorrhagie während Rechtsherzkatheteruntersuchung. Intensivmed 44, 520–525 (2007). https://doi.org/10.1007/s00390-007-0823-5

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  • DOI: https://doi.org/10.1007/s00390-007-0823-5

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