Tratamento cirúrgico da embolização de coil para artéria pulmonar após tentativa de fechamento percutâneo do canal arterial

Abstract

0infections. On physical examination, the patient was in good general condition, active, afebrile, acyanotic, eupneic, and his pulses were wide in his 4 limbs. His weight was 22 kg and his height 116 cm. His heart rate was 90 bpm, and his blood pressure was 100/50 mmHg. His precordial area showed no deformities, and the cardiac apex was palpated on the fifth left intercostal space in the midclavicular line. The second cardiac sound on the pulmonary focus had increased intensity. A continuous murmur of great intensity was heard in the high left sternal margin, accompanied by a thrill of equal intensity. The pulmonary auscultation was normal, and no visceromegaly was evidenced.The electrocardiogram showed sinus rhythm with a heart rate of 120 bpm, signs of left ventricular overload and diffuse alterations in ventricular repolarization. A simple chest X-ray showed a mildly enlarged cardiac area, bulging of the middle arch, and accentuation of the pulmonary vasculature, mainly in the hilar region.Doppler 2-dimensional echocardiography confirmed the clinical suspicion of persistent ductus arteriosus with increased pulmonary blood flow and a diameter of 4.5 mm. It was characterized as having moderate hemodynamic repercussion.The percutaneous treatment was chosen to close the ductus arteriosus. Because of the great dimension of the ductus arteriosus, 3 Gianturco coils (William Cook, Europe) were chosen and stacked. The procedure was not successful due to an accident in occluding the ductus arteriosus, with migration of the coils to the left pulmonary tree. In the same procedure, retrieval of 2 coils was possible; the last one became embedded in one branch of the left pulmonary artery, and could not be retrieved ( fig. 1).The patient underwent a complementary investigation to locate the precise site of coil embolization and to determine its repercussion on pulmonary perfusion. Pulmonary perfusion scintigraphy showed a decreased flow to the left lung (34%) as compared with that to the right lung (61%). In addition, chest computed tomography identified the presence of hypoattenuation of metallic density in the projection of the left descending interlobular artery.Because of the impairment of pulmonary perfusion to the left caused by coil embolization, surgical treatment was performed in a programmed and elective manner approximately 6 months after interventional catheterization. Under balanced general anesthesia, the following steps were taken: median sternotomy, longitudinal pericardiotomy, and installation of extracorporeal circulation through the ascending aorta and bicaval cannulation. Section and suture of the ductus arteriosus was performed during the cooling Case Report