Abstract
A 2-year-and-7-month-old boy underwent an emergent reconstruction surgery of the right ventricle-pulmonary artery (RV-PA) conduit. Although he was successfully weaned from cardiopulmonary bypass (CPB) after reconstruction of the RV-PA conduit, the bleeding continued despite the massive transfusion of red blood cell (RBC), fresh frozen plasma (FFP), and platelets. Because of persistent bleeding and abnormal coagulation laboratory results, we administered the recombinant activated factor VII (rFVIIa), which was not approved for use in the treatment of post-CPB coagulopathy. After administration of rFVIIa, his coagulation data dramatically improved, the bleeding decreased, and the operation was able to be finished.
Highlights
There have been increasing numbers of reports of “offlabel” use of the recombinant activated factor VII to achieve hemostasis in various situations including traumatic intractable bleeding [1, 2], cardiac surgery [3, 4], and obstetrical massive bleeding [4]
Twenty-two days after surgery, cardiac catheterization revealed that his right coronary artery was compressed by the right ventricle-pulmonary artery (RV-PA) conduit, and the emergent reconstitution of the RV-PA conduit was scheduled on the same day
We reported the use of rFVIIa in a child complicated with persistent bleeding after cardiac surgery under cardiopulmonary bypass (CPB)
Summary
There have been increasing numbers of reports of “offlabel” use of the recombinant activated factor VII (rFVIIa) to achieve hemostasis in various situations including traumatic intractable bleeding [1, 2], cardiac surgery [3, 4], and obstetrical massive bleeding [4]. Case presentation A 2-year-and-7-month-old boy with 22q11.2 deletion syndrome (height, 86 cm; body weight, 10 kg) was scheduled for an emergent surgery to reconstruct the right ventricle-pulmonary artery (RV-PA) conduit to remove its compression on his right coronary artery, causing the right ventricular failure. He was transferred to the Pediatric Intensive Care Unit (PICU). Fifty-two days after the second surgery, his sternum and skin were able to be closed, and he was discharged from PICU on day 157
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