title: Early post-operative thrombosis of the prosthetic mitral valve in patient with heparin-induced thrombocytopenia.
abstract: Heparin-induced thrombocytopenia (HIT) is one of the most common immune-mediated adverse drug reactions, with frequencies as high as 2-3% for certain groups of post-cardiac surgery patients. We report on an 50-year-old woman with early post-operative thrombosis of the prosthetic mitral valve due to heparin-induced thrombocytopenia. Non-invasive imaging (two-dimensional transesophageal echocardiography; 2D-TEE) allowed the exact localisation of thrombotic masses and revealed the increase of the mean diastolic mitral gradient. The HIT diagnosis was proved by the clinical scoring system, and with the identification of heparin platelet factor 4-induced antibodies. After the withdrawal of LMWH therapy and the start of intravenous lepirudin treatment, the patient's medical condition improved continuously. Follow-up echocardiography showed a step-wise decrease in the severity of the mean diastolic mitral valve gradient and a complete resolution of thrombus formations. Perhaps we may remind ourselves that, whilst HIT is one of the most common immune-mediated adverse drug reactions for certain groups of post-cardiac surgery patients, it can be managed successfully. We would also stress the importance of serial 2D-TEE examinations in the early post-operative period.
authors.affiliation: Heart Institute, Faculty of Medicine, University of Pécs, Ifjúság u 13, Pécs, Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Cziráki
authors.forename: Zénó
authors.initials: Z
authors.lastname: Ajtay
authors.forename: Agnes
authors.initials: A
authors.lastname: Nagy
authors.forename: László
authors.initials: L
authors.lastname: Márton
authors.forename: Zsófia
authors.initials: Z
authors.lastname: Verzár
authors.forename: Sándor
authors.initials: S
authors.lastname: Szabados
mesh_terms: D000925:Anticoagulants / Q000009:adverse effects*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006493:Heparin / Q000009:adverse effects*; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D013921:Thrombocytopenia / Q000139:chemically induced* / Q000150:complications; D013927:Thrombosis / Q000209:etiology*; D013997:Time Factors
chemical_list: D000925:Anticoagulants; D006493:Heparin