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This article discusses a pulmonary artery pseudoaneurysm (PAP) formation following pulmonary artery catheter (PAC) placement for cardiac surgery. The patient, an 82-year-old female with a history of hypertension and chronic heart failure, underwent elective mitral and tricuspid valve surgery. After surgery, bleeding was observed in the endotracheal tube, indicating a potential complication. Fiberoptic bronchoscopy revealed bleeding mainly in the right bronchus. Subsequent computed tomography pulmonary angiogram (CTPA) confirmed the presence of a small pseudoaneurysm in a branch of the pulmonary artery. Prompt collaboration between anesthesiologists, cardiac surgeons, and interventional radiologists led to the successful embolization of the pseudoaneurysm with a minimally invasive approach by using the PAC as a guide catheter to reach the PAP. The article outlines the potential causes of PAP formation, clinical presentation, and management strategies. While conservative, surgical, and interventional approaches are discussed, the preferred treatment is coil embolization due to its effectiveness and minimal invasiveness. The authors emphasize the importance of rapid diagnosis, multidisciplinary collaboration, and the feasibility of using the pulmonary artery route for embolization to rapidly reach the lesion to stabilize. Overall, the case demonstrates the successful resolution of a life-threatening complication through timely intervention and coordinated teamwork. [ABSTRACT FROM AUTHOR]

perioperative hyperglycemia is common in patients undergoing cardiac surgery and it is associated with increased risks of mortality and morbidity1. The pathogenesis of perioperative dysglycemia is a complex interaction between underlying patient's condition (diabetes, metabolic syndrome) and surgical stress. This study evaluates an intraoperative glucose control protocol designed according to the European Association for Cardio-Thoracic Surgery (EACTS) guidelines2 to manage blood glucose levels during surgery. we developed an intraoperative blood glucose (BG) control protocol (figure 1) with a target of BG <180 mg/dL. Patients were divided into three risk categories: very high (HH) for type 1 diabetes, high (H) for insulin-dependent or non-insulin- dependent diabetes, metabolic syndrome, or chronic steroid therapy, and low (L) for patients without these conditions. BG was measured first after general anesthesia induction, subsequently every 30-40 minutes, the last measurement was at ICU admission. Insulin therapy was started at BG>180 mg/dL for H and L groups, and BG>110 mg/dL for HH group. Patients with urgent or emergent surgeries were treated as H group regardless their comorbidities. 1-year retrospective analysis (March, 2023 – March, 2024). Data were analyzed by Sigmastat 11 (SPSS inc. Chicago, IL) and presented as mean ± SD or median [interquartile range], t-test was used for comparisons. 495 patients were treated with this protocol. Data from 442 patients (HH=1; H=266; L=175) were analyzed, while 53 patients (10%) were excluded due to incorrect protocol application. Overall 180 (41%) patients underwent glycemic control protocol as described above (HH n=1, 100%, H n=125, 46% and L n=54, 31%).344 patients underwent elective surgery and 35% of these (n=120; group L n= 53, 44%; group H n= 67, 56%) needed insulin protocol. Urgent surgeries showed a higher prevalence of hyperglycemia, affecting 60 of 97 patients (62%). Figure 2 describes intraoperative BG (off-pump surgery n=16, 3%; on-pump surgery n=426, 96% with CPB time = 107 [88-128] minutes). At the end of surgery, BG was on average under 180 mg/dl in all groups and urgent surgery. In the elective group BG at ICU admission was 145±40 mg/dL in patients with intraoperative insulin protocol, versus 136±25 mg/dL in patients who did not require insulin (p=0.010). A higher difference (<0.01) was observed in BG at ICU admission between patients that required insulin protocol and who did not (165±59 versus 129±24 mg/dL). Mild hypoglycemia was observed in 3 cases, all during elective surgery. Two patients in group H (BG 69 and 66 mg/dL) and one patient in group L (BG 57 mg/dL), treated without any complication. The protocol showed to be effective in managing intraoperative hyperglycemia, as reflected by a good glycemic control at ICU admission. The stratification of patients by risk allowed a more tailored approach which optimal BG control and minimal hypoglycemia risk. Furthermore, urgent surgery remains a significant trigger for hyperglycemia, resulting in more patients requiring the protocol application with less efficacy than the elective group. [ABSTRACT FROM AUTHOR]