Shunt operations improved thrombocytopenia in a patient with congenital cyanotic heart disease.
Cardiac and vascular intervention in thrombocytopenic congenitally cyanotic patients is more dangerous. Thrombocytopenia in these patients is related to immune thrombocytopenia, polycythemia, hyperviscosity, pseudothrombocytopenia, and drugs. Herein we report on a thrombocytopenic 8-year-old girl with tricuspid valve atresia and pulmonary valve stenosis admitted for catheterization. Thrombocytopenia (21,000/mm3) and shunt occlusion was noticed. Thrombocytopenia did not recover after intravenous immunoglobulin (IVIG) and phlebotomy therapies. During preparation for surgery, she suffered cardiopulmonary arrest. A Gore-tex graft was placed in the right pulmonary artery and truncus brachiocephalicus. After surgery, her platelet count spontaneously increased to within the normal range (178,000/mm3 to 250,000/mm3). After resuscitation, she had right-sided hemiplegia sequelae, though there were no hemorrhagic findings on cranial magnetic resonance imaging (MRI) or computed tomography (CT) scans. Two months after surgery, the Blalock-Taussig (BT) shunt blood flow decreased, thrombocyte count dropped, and peripheral cyanosis reappeared. A Fontan operation was performed without hemorrhagic events, and after surgery the thrombocyte count reached 330,000/mm3. We suggest that if a patient with cyanotic heart disease has thrombocytopenia and there is no apparent cause, hypoxia-related thrombocytopenia must be considered. After reoxygenation by shunt or corrective surgeries, thrombocyte count and functions will recover.
Olgar
Seref
S
Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
Ertugrul
Turkan
T
Nisli
Kemal
K
Devecioglu
Omer
O
Turkan
Elmaci
E
D019917:Blood Vessel Prosthesis Implantation; D006348:Cardiac Surgical Procedures; D016887:Cardiopulmonary Resuscitation; D002648:Child; D017023:Coronary Angiography / Q000009:adverse effects*; D003326:Coronary Circulation; D003490:Cyanosis / Q000209:etiology / Q000601:surgery; D005260:Female; D018729:Fontan Procedure; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy; D006801:Humans; D000860:Hypoxia / Q000209:etiology / Q000628:therapy; D016756:Immunoglobulins, Intravenous / Q000627:therapeutic use; D018962:Phlebotomy; D017713:Platelet Transfusion; D011652:Pulmonary Circulation; D011666:Pulmonary Valve Stenosis / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D012086:Reoperation; D013921:Thrombocytopenia / Q000209:etiology / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D018785:Tricuspid Atresia / Q000150:complications / Q000503:physiopathology / Q000601:surgery*
D016756:Immunoglobulins, Intravenous