title: Shunt operations improved thrombocytopenia in a patient with congenital cyanotic heart disease.
abstract: 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.
authors.affiliation: Department of Pediatric Cardiology, Istanbul University, Istanbul Faculty of Medicine, Istanbul, Turkey.
authors.forename: Seref
authors.initials: S
authors.lastname: Olgar
authors.forename: Turkan
authors.initials: T
authors.lastname: Ertugrul
authors.forename: Kemal
authors.initials: K
authors.lastname: Nisli
authors.forename: Omer
authors.initials: O
authors.lastname: Devecioglu
authors.forename: Elmaci
authors.initials: E
authors.lastname: Turkan
mesh_terms: 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*
chemical_list: D016756:Immunoglobulins, Intravenous