title: Management of intracranial hemorrhage in a child with a left ventricular assist device.
abstract: Pediatric patients bridged to heart transplant with LVADs require chronic anticoagulation and are at increased risk of hemorrhagic complications, including intracranial hemorrhage. In this population, intracranial hemorrhage is often fatal. We report a case of successful management of a five-yr-old-boy with DCM on an LVAD who developed a subdural hematoma. We initially chose medical management, weighing the patient's high risk of thromboembolism from anticoagulation reversal against the risk of his chronic subdural hematoma. When head CT showed expansion of the hemorrhage with increasing midline shift, we chose prompt surgical evacuation of the hematoma with partial reversal of anticoagulation, given the increased risk of acute deterioration. The patient ultimately received an orthotopic heart transplant and was discharged with no permanent neurological complications. This represents a case of a pediatric patient on an LVAD who survived a potentially fatal subdural hematoma and was successfully bridged to cardiac transplantation.
authors.affiliation: Department of Neurological Surgery, College of Physicians and Surgeons, Neurological Institute of New York, Columbia University, New York, NY 10032, USA.
authors.forename: Raqeeb
authors.initials: R
authors.lastname: Haque
authors.forename: Teresa
authors.initials: T
authors.lastname: Wojtasiewicz
authors.forename: Rabin
authors.initials: R
authors.lastname: Gerrah
authors.forename: Lisa
authors.initials: L
authors.lastname: Gilmore
authors.forename: Yoshikatsu
authors.initials: Y
authors.lastname: Saiki
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Chen
authors.forename: Marc
authors.initials: M
authors.lastname: Richmond
authors.forename: Neil A
authors.initials: NA
authors.lastname: Feldstein
authors.forename: Richard C E
authors.initials: RC
authors.lastname: Anderson
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects* / Q000627:therapeutic use; D002675:Child, Preschool; D004359:Drug Therapy, Combination / Q000009:adverse effects; D006333:Heart Failure / Q000150:complications / Q000601:surgery*; D006353:Heart-Assist Devices; D020200:Hematoma, Subdural, Chronic / Q000139:chemically induced / Q000000981:diagnostic imaging / Q000628:therapy*; D006801:Humans; D008297:Male; D011859:Radiography; D013927:Thrombosis / Q000209:etiology / Q000517:prevention & control
chemical_list: D000925:Anticoagulants