Anesthetic Management in a Patient with Pulmonary Artery (PA) Perforation by PA Flow-directed Catheter

A 54-year-old woman was admitted for evaluation of mitral stenosis and regurgitation. A flowdirected balloon-tipped catheter was passed into the PA without difficulty. Immediately after measuring the PA wedge pressure, she suddenly showed cough and hemoptysis and developed profound systemic hypotention. PA angiogram revealed extravation of contrast medium into the right pleural space. Immediately she was taken to the operating room and emergency thoracotomy was performed. The bleeding point was easily identified in the right main PA and quickly oversewn. On the following day, active bleeding was found via the chest tube. The hemostatic surgery was performed with electrocautery. Then, severe pulmonary hypertension and hypoxemia persisted, and pulmonary edema occurred frequently with foamy bronchial secretions. It was felt that her chance for survival would be enhanced by mitral valve replacement. The surgery was undertaken on the 23th postoperative day. She recovered uneventfully and discharged from the ICU on the 30th postoperative day. We reported her perioperative management and discussed potential adverse effects of the PA catheter insertion.