ABSTRACT
A 57-year-old man developed transient global amnesia within an hour of bolus unfractionated heparin administration on day 4 post-mitral valve replacement. Both immunoglobulin G-specific enzyme-linked immunosorbent assay and serotonin release assay were strongly positive for the antibodies that cause heparin-induced thrombocytopenia. The patient's cognitive functions returned to normal following discontinuation of unfractionated heparin and warfarin and commencement of lepirudin infusion.
Subject(s)
Amnesia, Transient Global/diagnosis , Anticoagulants/adverse effects , Heparin/adverse effects , Thrombocytopenia/complications , Warfarin/adverse effects , Amnesia, Transient Global/chemically induced , Anticoagulants/therapeutic use , Heart Valve Prosthesis Implantation , Hirudins , Humans , Male , Middle Aged , Mitral Valve/pathology , Recombinant Proteins/therapeutic use , Thrombocytopenia/chemically induced , Time FactorsABSTRACT
We describe a case of electromechanical dissociation (EMD) in a 62-year-old female patient following insertion of a Medtronic Hall mitral valve prosthesis. She initially developed pulsus alternans which led, over a few hours, to intermittent electromechanical dissociation. Clinical and echocardiographic findings are described. Emergency surgical intervention revealed a piece of chorda wedged between the disc occluder and the valve ring. This case illustrates clinical and Doppler echocardiographic features associated with a rare presentation of an unusual perioperative complication of prosthetic mitral valve dysfunction. We have also included a brief review of related literature.
