[Intraoperative Subsegmental Pulmonary Artery Embolization for Catheter Induced Pulmonary Pseudoaneurysm]

An 82-year-old female patient with severe aortic stenosis underwent aortic valve replacement. After weaning from cardiopulmonary bypass, it was noticed that Swan-Ganz( SG) catheter tip was located 50 cm distally to the right neck. After the catheter was pulled back, massive hemoptysis occurred. Fiberoptic bronchoscopy revealed bleeding from the left main bronchus. The tracheal tube was exchanged to a left selective bronchial tube and protamine sulfate was administered. However, massive hemorrhage continued. Intraoperative selective pulmonary angiography identified a pseudoaneurysm in A10. Efferent arteries, A10a, A10b, A10c, and an afferent artery, A10, were successfully embolized to obtain hemostasis. The patient remained hypoxemic despite inhalation with 100% oxygen and high positive end-expiratory pressure, so veno-arterial extracorporeal membrance oxygenation (VA-ECMO) was initiated. The patient was then transferred to intensive care unit (ICU) with VA-ECMO and the sternum was left open. Strenuous bronchial lavage was performed and VA-ECMO was discontinued at 2 days later. The patient was weaned from ventilator 14 days and discharged 63 days postoperatively.