ABSTRACT
The intraaortic balloon pump (IABP) is the most effective and widely used device for temporary mechanical assistance of left heart. Considering left and right ventricular (RV) interdependence, IABP may also alleviate predominantly RV dysfunction following cardiac surgery. This is the case of a 61-year-old female patient who had experienced RV failure after cardiac surgery. After tricuspid valve replacement, preexisting RV failure was progressively aggravated and systemic blood pressure could not be maintained in spite of aggressive pharmacological support on second postoperative day. Thus, mechanical support with IABP was considered to increase coronary perfusion pressure in this case. IABP dramatically improved hemodynamics and cardiac function. It was removed on fifth postoperative day and she has remained well. In conclusion, IABP could play a role in RV failure following cardiac surgery and timely treatment of the heart failure with mechanical circulatory assistance would prevent further complications.
Subject(s)
Female , Humans , Middle Aged , Blood Pressure , Heart , Heart Failure , Hemodynamics , Perfusion , Thoracic Surgery , Tricuspid ValveABSTRACT
Appropriate anticoagulation is essential for safe cardiopulmonary bypass (CPB). Two patients with infective endocarditis were scheduled for valve replacement. After an intravenous heparin injection for the CPB, the increases in the activated clotting time (ACT) in both patients were less than expected. Subsequent additional heparin administration failed to maintain a sufficient ACT for the CPB, and antithrombin III (AT III) tests during the CPB revealed low activities in both patients. Heparin resistance, due to consumption of circulating AT III as a result of infective endocarditis or prior heparinization, was postulated. While fresh frozen plasma (FFP) could not be timely administered in the first patient, ACT was successfully prolonged after the administration of FFP in the second. It is strongly suggested that adequate management of heparin resistance should be prepared for patients with infective endocarditis who require CPB.
Subject(s)
Humans , Antithrombin III , Antithrombin III Deficiency , Cardiopulmonary Bypass , Endocarditis , Heparin , PlasmaABSTRACT
Appropriate anticoagulation is essential for safe cardiopulmonary bypass (CPB). Two patients with infective endocarditis were scheduled for valve replacement. After an intravenous heparin injection for the CPB, the increases in the activated clotting time (ACT) in both patients were less than expected. Subsequent additional heparin administration failed to maintain a sufficient ACT for the CPB, and antithrombin III (AT III) tests during the CPB revealed low activities in both patients. Heparin resistance, due to consumption of circulating AT III as a result of infective endocarditis or prior heparinization, was postulated. While fresh frozen plasma (FFP) could not be timely administered in the first patient, ACT was successfully prolonged after the administration of FFP in the second. It is strongly suggested that adequate management of heparin resistance should be prepared for patients with infective endocarditis who require CPB.