Pulmonary microthrombi during left ventricular assist device implantation

Igor D. Gregoric, Vijaykumar Surendrakant Patel, Rajko Radovancevic, Arthur W. Bracey, Branislav Radovancevic, O. H. Frazier

Research output: Contribution to journalArticle

4 Scopus citations

Abstract

Critically ill heart failure patients undergoing left ventricular assist device implantation have alterations in their coagulation profiles; as a result, hemorrhagic complications during the postoperative period are the most common and serious problems during device support of these patients. The use ofaprotinin therapy is generally accepted for reducing bleeding after coronary artery bypass grafting procedures, heart transplantation, and insertion of a left ventricular assist device. We describe the case of a patient who had a suprasystemic increase in pulmonary artery pressure, caused by thromboembolic occlusion of the pulmonary arterioles after urgent implantation of a left ventricular assist device. The complications developed after the patient was weaned from cardiopulmonary bypass and heparinization was reversed with protamine. Although the thrombosis was successfully reversed with intraoperative administration of tissue plasminogen activator directly to the pulmonary artery, the patient died of massive hemorrhage 6 hours later. To our knowledge, the direct application of tissue plasminogen activator into the pulmonary artery in such a catastrophic situation has not been used elsewhere.

Original languageEnglish (US)
Pages (from-to)228-231
Number of pages4
JournalTexas Heart Institute Journal
Volume32
Issue number2
StatePublished - Jun 22 2005
Externally publishedYes

Keywords

  • Aprotinin/administration & dosage/adverse effects
  • Blood coagulation/drug effects
  • Blood loss, surgical/prevention and control
  • Heart failure, congestive
  • Heart-assist devices/adverse effects
  • Heparin
  • Postoperative complications/mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Gregoric, I. D., Patel, V. S., Radovancevic, R., Bracey, A. W., Radovancevic, B., & Frazier, O. H. (2005). Pulmonary microthrombi during left ventricular assist device implantation. Texas Heart Institute Journal, 32(2), 228-231.