Catheter-induced pulmonary artery rupture in the setting of cardiopulmonary bypass.

Pulmonary artery rupture is an infrequent complication of flow-directed catheters. Because cardiopulmonary bypass offers an opportunity for control of gas exchange and hemorrhage, pulmonary artery rupture in this setting is different from that occurring in the intensive care unit and catheterization laboratory. A collective review of 30 published cases was conducted. Sixty-nine percent of patients were female and 50% had valvular heart disease. The right pulmonary artery was injured in 93% of cases. Arterial rupture presented with airway hemorrhage in 29 of 30 patients. Six patients presented with a herald airway bleed after catheter insertion but before operation. Three of 4 patients died when operation was performed in the face of a herald bleed. Airway hemorrhage most commonly developed during bypass weaning (19 cases). Recurrent hemorrhage occurred in 45% of patients (9/20) treated conservatively compared with 0% (0/7) in those having surgical control of bleeding (p = 0.07). Three patients died in the operating room. Overall mortality was 41%. Uncontrolled hemorrhage was the leading cause of death. Conservative management strategies are associated with a high incidence of secondary, often fatal, hemorrhage. Although pulmonary resection controls bleeding, mortality from other causes is a problem. A treatment protocol is proposed that considers these management dilemmas.