scholarly journals Cardiac surgery in patients with heparin induced thombocytopenia (HIT II)

2009 ◽  
Vol 56 (1) ◽  
pp. 47-52
Author(s):  
M.D. Jovic ◽  
D.G. Nezic ◽  
B.M. Calija ◽  
D.S. Nenadic ◽  
A.M. Knezevic ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulant Therapy ◽  
Anticoagulation Therapy ◽  
Thrombin Inhibitors ◽  
Postoperative Treatment ◽  
Per Oral

Heparin-induced thrombocytopenia (HIT) might be lifethreatening in patients undergoing open heart surgery, due to thromboembolic events, thrombocytopenia and bleeding. If cardiac surgery with cardiopulmonary bypass (CPB) is necessary, anticoagulation therapy will be based on usage of danaparoid or direct thrombin inhibitors. Female patient was switched from per oral anticoagulant therapy to low molecular heparin therapy preparing for reredo mitral valve replacement due to endocarditis and artificial valve thrombosis. In next 10 days, thrombocytopenia was obvious (Tr 302 000 mm3 to 11 000 mm3) , and diagnoses of HIT were done. Anticoagulant therapy was continued with danaparoid, 750 IU/12 h sc. During the surgery, reredo mitral valve replacement and aortocoronary bypass on anterior descending coronary artery, blood salvage technique with rhirudin( intravenous bolus 0,4 mg/kg, in CPB prajming solution 0,4mg/kg and continuous infusion during CPB 0,15 mg/kg/h ) during cardiopulmonary bypass was used. Active coagulation time and +++ were monitored, without any sign of micro thrombosis in circuit. Postoperatively, per oral anticoagulation therapy was initiated with prolonged postoperative treatment due to basic disease, endocarditis. Patient was discharged from hospital on 21-st postoperative day without any complication.

Acquired submitral aneurysms may be associated with mitral paravalvular leaks

2021 ◽  
pp. 021849232110063
Author(s):  
Palaparti Raghuram ◽  
Kothandam Sivakumar ◽  
Ejaz Ahamed Sheriff
Keyword(s):  
Cardiopulmonary Bypass ◽  
High Risk ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Transcatheter Closure ◽  
Alternative Solution ◽  
Surgical Trauma ◽  
Ideal Solution ◽  
Repeat Surgery

Acquired submitral aneurysm after mitral valve replacement is caused by weakness of the annular tissues induced by inflammation, scarring, and ischemia from surgical trauma. The asynchronous stretch of the annulus caused by the submitral aneurysm may cause recurrent paravalvular leaks. In patients with acquired submitral aneurysms and paravalvular leaks, ideal solution is a repeat surgery to address both the aneurysm and the leak. However, when patients are at high risk for repeat surgeries on cardiopulmonary bypass through sternotomy, transcatheter closure of these paravalvar leaks may offer an alternative solution. Four such procedures in three patients are detailed in this report.

scholarly journals Perioperative Cerebral Ischaemia in Cardiac Surgery and BIS

2005 ◽  
Vol 33 (4) ◽  
pp. 514-517 ◽  
Author(s):  
J. Villacorta ◽  
F. Kerbaul ◽  
F. Collart ◽  
C. Guidon ◽  
M. Bonnet ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Ct Scan ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Bispectral Index ◽  
Cerebral Ischaemia ◽  
Air Embolism ◽  
Aortic Cross Clamp ◽  
Bispectral Index Monitoring

A 46-year-old woman was monitored by bispectral index monitoring (BIS) during redo aortic and mitral valve replacement. On release of the aortic cross clamp there was a sudden, severe, unexplained, and sustained fall in the BIS value. Postoperatively, a CT scan was consistent with multiple ischaemic lesions. The lesions were presumed to be due to air embolism. This case suggests that a sudden unexplained and persistent fall in BIS may indicate cerebral ischaemia.

scholarly journals Transcatheter Mitral Valve Replacement and Thrombosis: A Review

2021 ◽  
Vol 8 ◽  
Author(s):  
Guido Ascione ◽  
Paolo Denti
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulation Therapy ◽  
Unmet Need ◽  
Left Ventricular ◽  
Current Evidence ◽  
Thrombotic Risk ◽  
Transcatheter Mitral Valve Replacement

Mitral regurgitation is the most prevalent form of moderate or severe valve disease in developed countries. Surgery represents the standard of care for symptomatic patients with severe mitral regurgitation, but up to 50% of patients are denied surgery because of high surgical risk. In this context, different transcatheter options have been developed to address this unmet need. Transcatheter mitral valve replacement (TMVR) is an emergent field representing an alternative option in high complex contexts when transcatheter mitral valve repair is not feasible or suboptimal due to anatomical issues. However, TMVR is burdened by some device-specific issues (device malposition, migration or embolization, left ventricular outflow tract obstruction, hemolysis, thrombosis, stroke). Here we discuss the thrombotic risk of TMVR and current evidence about anticoagulation therapy after TMVR.

scholarly journals THE USE OF TISSUE PROSTHESIS FOR MITRAL VALVE REPLACEMENT: POSSIBILITY OF DISCONTINUATION OF ANTICOAGULATION

2018 ◽  
Vol 7 (3) ◽  
pp. 72-82 ◽  
Author(s):  
Yu. N. Odarenko ◽  
N. V. Rutkovskaya ◽  
E. V. Gorbunova ◽  
E. A. Khomenko ◽  
S. G. Kokorin ◽  
...  
Keyword(s):  
Catheter Ablation ◽  
Mitral Valve ◽  
Sinus Rhythm ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Anticoagulation Therapy ◽  
Maze Procedure ◽  
Efficacy Rate ◽  
Bioprosthetic Mitral Valve

Aim. To evaluate the clinical efficacy of gradual sinus rhythm restoration, including the bioprosthetic mitral valve replacement combined with maze radiofrequency ablation, external cardioversion and catheter ablation.Methods.102 medical records of patients with mitral valve disease and long-standing atrial fibrillation (4,7±2,7 years) were restrospectively reviewed. Maze procedure was performed under extracorporeal circulation before the mitral valve replacement. The endpoints were monitored at the day of surgery, at discharge, and 3, 6 and 12 months after surgery.Results.Sinus rhythm was recorded in 65.7% of patients at discharge from the hospital. The completeness of the follow-up was 80.4%. Steady regular rhythm was maintained in 64.6 % of patients in the study group. Other patients (35.4%) underwent cardioversion with the efficacy rate of 41.4%. Anticoagulation therapy was withdrawn in 65.9% of patients three months after surgery. 18.3% of patients with symptomatic arrhythmia underwent catheter ablation, which allowed to restore sinus rhythm in 73.3% of cases. Sinus rhythm was recorded in 92.7% of cases within the 1-year follow-up. Importantly, 79.3% of patients were discontinued of indirect anticoagulants.Conclusion.Discontinuation of indirect anticoagulants proved its beneficial effects and safety on the restoration of sinus rhythm in patients after bioprosthetic mitral valve replacement.

Reversal of Ischemic Hepatitis after Cardiac Surgery under Cardiopulmonary Bypass: A Case Report

2020 ◽  
Vol 3 (2) ◽  
pp. 36-37
Author(s):  
Lokesh Shekher Jaiswal ◽  
Narendra Pandit ◽  
Jagat Narayan Prasad
Keyword(s):  
Cardiac Surgery ◽  
Case Report ◽  
Cardiopulmonary Bypass ◽  
Mitral Valve ◽  
Cardiogenic Shock ◽  
Valve Replacement ◽  
Fulminant Hepatic Failure ◽  
Hepatic Failure ◽  
Acute Hepatic Failure ◽  
Ischemic Hepatitis

Acute hepatic failure due to ischemic hepatitis is associated with high mortality. The safety of cardiopulmonary bypass in this setting is not fully described. Here we report a case of a 21-year-old female who developed an acute fulminant hepatic failure due to ischemic hepatitis following a cardiogenic shock. She underwent subsequent successful mitral valve replacement under cardiopulmonary bypass, thus providing an evidence of its safety in acute fulminant hepatic failure.

scholarly journals Massive Left Atrial Thrombus in Two Patients with Heparin-Induced Thrombocytopenia Type II after Cardiac Surgery

TH Open ◽  
2018 ◽  
Vol 02 (03) ◽  
pp. e334-e337 ◽  
Author(s):  
Yuriy Mandryk ◽  
Markus Czesla ◽  
Christian Mogilansky ◽  
Kristina Stefkova ◽  
Aloys Drees ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Left Atrial ◽  
Surgical Patients ◽  
Type Ii ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Heparin Induced Thrombocytopenia

AbstractHeparin-induced thrombocytopenia type II (HIT type II) can have devastating consequences in cardiac surgical patients. We report two cases of massive left atrial thrombus after mitral valve replacement and endocardial cryoablation in patients with HIT type II.

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