Pulmonary endarterectomy (PEA) is a technically demanding operation, currently performed in few centers worldwide. 1 A bloodless surgical field is mandatory to identify the correct arterial dissection plane, which has to be extended toward subsegmental branches with limited visibility. Vessel perforation is a rare but potentially fatal complication, leading to uncontrollable airway bleeding. A general algorithm for the approach to pulmonary hemorrhage has been proposed by the group from the University of California at San Diego,2 whereas alternative managements are only briefly mentioned in the literature.3 Extracorporeal life support unloads pulmonary circulation but invariably requires anticoagulation, which is detrimental in pulmonary hemorrhage. We describe a novel technique for the treatment of intraoperative airway bleeding during PEA.
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