title: Pulmonary microthrombi during left ventricular assist device implantation.
abstract: Critically ill heart failure patients undergoing left ventricular assist device implantation have alterations in their coagulation profiles; as a result, hemorrhagic complications during the postoperative period are the most common and serious problems during device support of these patients. The use of aprotinin therapy is generally accepted for reducing bleeding after coronary artery bypass grafting procedures, heart transplantation, and insertion of a left ventricular assist device. We describe the case of a patient who had a suprasystemic increase in pulmonary artery pressure, caused by thromboembolic occlusion of the pulmonary arterioles after urgent implantation of a left ventricular assist device. The complications developed after the patient was weaned from cardiopulmonary bypass and heparinization was reversed with protamine. Although the thrombosis was successfully reversed with intraoperative administration of tissue plasminogen activator directly to the pulmonary artery, the patient died of massive hemorrhage 6 hours later. To our knowledge, the direct application of tissue plasminogen activator into the pulmonary artery in such a catastrophic situation has not been used elsewhere.
authors.affiliation: The Department of Cardiopulmonary Transplantation, Texas Heart Institute at St. Luke's Episcopal Hospital, Houston, Texas 77030, USA.
authors.forename: Igor D
authors.initials: ID
authors.lastname: Gregoric
authors.forename: Vijay
authors.initials: V
authors.lastname: Patel
authors.forename: Rajko
authors.initials: R
authors.lastname: Radovancevic
authors.forename: Arthur W
authors.initials: AW
authors.lastname: Bracey
authors.forename: Branislav
authors.initials: B
authors.lastname: Radovancevic
authors.forename: O H
authors.initials: OH
authors.lastname: Frazier
mesh_terms: D001777:Blood Coagulation; D001794:Blood Pressure; D005260:Female; D006353:Heart-Assist Devices; D006801:Humans; D007431:Intraoperative Complications / Q000188:drug therapy*; D008875:Middle Aged; D010960:Plasminogen Activators / Q000008:administration & dosage / Q000627:therapeutic use*; D011651:Pulmonary Artery / Q000503:physiopathology; D011655:Pulmonary Embolism / Q000188:drug therapy / Q000209:etiology*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D010960:Plasminogen Activators; D010959:Tissue Plasminogen Activator