Abstract
We describe a patient who developed catastrophic consequences of heparin-induced thrombocytopenia (HIT) post car¬diac surgery, for which she required reoperation using CPB. We also illustrate the impact of intraoperative transe¬sophageal echocardiography (TEE) in the surgical management of this patient.
Highlights
MethodsIntra-operative transesophageal echocardiography (TEE) was performed, and showed a left atrial (LA) thrombus, in addition to the RA thrombusIJCM visualized on the preoperative TEE
We describe a patient who developed catastrophic consequences of heparin-induced thrombocytopenia (HIT) post cardiac surgery, for which she required reoperation using cardiopulmonary bypass (CPB)
In 2004, a 51-year-old woman underwent coronary artery bypass grafting surgery complicated by heparin-induced thrombocytopenia with thrombosis 9 days post operatively
Summary
Intra-operative TEE was performed, and showed a left atrial (LA) thrombus, in addition to the RA thrombusIJCM visualized on the preoperative TEE. Under full CPB, the RA and LA thrombi were excised, and the patient underwent bilateral pulmonary embolectomy She required 7 U PRBC's, 12 U platelets, and 4 U FFP's. In the Intensive Care, the patient was titrated off pressor and inotropic support 2 days postoperatively. She received 3 more U PRBCs, 8 U FFPs, and 10 U cryoprecipitate. A CT of the head revealed a right temporo-parietal infarct with mild right parietal hemorrhagic transformation and mass effect on the right ventricle. Her weakness improved gradually with physiotherapy, and she was discharged to Rehabilitation on Coumadin and Entrophen
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