title: Heparin-induced thrombocytopenia complicating support by the Berlin Heart.
abstract: Since 1992, miniaturized pulsatile air-driven ventricular assist devices (VADs), "Berlin Heart," have been used at many institutions (36 cases in North America in 19 different institutions) for pediatric use. Heparin-induced thrombocytopenia (HIT II) is a significant complication rarely reported in the setting of adult VAD support; no similar report exists concerning pediatric VAD support. We report on a 13-month-old, 8.1 kg girl who required LVAD support for cardiogenic shock of unclear etiology. The patient had a history of multiple surgical repairs for correction of complex congenital heart disease consisting of a series of left heart obstructive lesions (Shone's complex). Despite aggressive ventilatory and inotropic support, the patient continued to deteriorate and subsequently required extracorporeal life support. After 7 days of conventional venoarterial extracorporeal membrane oxygenation, a 10 ml Berlin Heart VAD was implanted. After implantation, the patient developed persistent low-grade fever of unclear etiology, gradual thrombocytopenia, and deterioration of renal function. On postimplant day 10, the pump required replacement because of concerns about an inlet valve thrombus; the explanted device demonstrated a nearly occlusive clot not appreciable from external inspection. Simultaneously, HIT II was diagnosed as a result of hematology workup for persistent thrombocytopenia. We discuss the unique challenges posed by HIT II complicating pediatric VAD support and in relation to the heparin coating of the device.
authors.affiliation: Division of Pediatric Cardiothoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA. Pirooz.Eghtesady@cchmc.org
authors.forename: Pirooz
authors.initials: P
authors.lastname: Eghtesady
authors.forename: David
authors.initials: D
authors.lastname: Nelson
authors.forename: Steven M
authors.initials: SM
authors.lastname: Schwartz
authors.forename: Derek
authors.initials: D
authors.lastname: Wheeler
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Pearl
authors.forename: Linda H
authors.initials: LH
authors.lastname: Cripe
authors.forename: Peter B
authors.initials: PB
authors.lastname: Manning
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006330:Heart Defects, Congenital / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D012770:Shock, Cardiogenic / Q000209:etiology / Q000628:therapy; D013921:Thrombocytopenia / Q000209:etiology* / Q000276:immunology
chemical_list: D000925:Anticoagulants; D006493:Heparin