チアノーゼ性心疾患術後の気道出血管理

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  • Airway Bleeding after Cardiac Surgery for Cyanotic Congenital Heart Disease

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Airway bleeding is one of the complications of cardiac surgery for cyanotic congenital heart disease. Sometimes conservative therapy is ineffective and death results. However, there are no definitive indications for invasive therapy. We retrospectively analyzed 53 cases of airway bleeding after cardiac surgery for cyanotic congenital heart disease between 1983 and 1993 at our institution. The greatest number of patients were suffering from pseudotruncus arteriosus. We classified the patients on the basis of efficacy of conservative therapy as follows: group 1, effective; group 2, ineffective. The mean duration of airway bleeding in group 2 (6.8 days) was significantly longer than in group 1 (2.9 days). In group 1 more than 80% of the patients stopped bleeding within 3 days, and it persisted over 5 days in only 10%. We attempted invasive therapy to treat the intractable airway bleeding in two patients by bronchial artery embofization, in two patients by pulmonary lobectomy, and in one patient compression with a Fogarty catheter. Airway bleeding was stopped in every patient except one who died intraoperatively. We conclude that invasive therapy should be considered in patients in which airway bleeding lasts more than 5 days.

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