title: Prothrombin Complex Concentrate and Methylene Blue for Treatment of Coagulopathy and Vasoplegia in a Pediatric Heart Transplant Patient.
abstract: Ventricular assist devices (VADs) are associated with conditions that may complicate the perioperative course of pediatric heart transplants. A 7-year-old girl with dilated cardiomyopathy supported by a Toyobo-NCVC left VAD (Toyobo-National Cardiovascular Center, Osaka, Japan), a pulsatile extracorporeal device, and preoperatively anticoagulated with warfarin presented for orthotopic heart transplant. The course was complicated by persistent bleeding treated with prothrombin complex concentrate and refractory postbypass vasoplegia treated with methylene blue. Preoperative anticoagulation and the presence of a VAD are associated with postbypass coagulopathy and vasoplegia. We describe a case in which these conditions were successfully treated with no thrombotic complications and minimal need of vasopressors for hemodynamic stability.
authors.affiliation: From the Department of Anesthesiology, Columbia University Medical Center, New York, New York.
authors.forename: Jennifer K
authors.initials: JK
authors.lastname: Lee
authors.forename: Caleb
authors.initials: C
authors.lastname: Ing
mesh_terms: D001779:Blood Coagulation Factors / Q000008:administration & dosage* / Q000627:therapeutic use; D002311:Cardiomyopathy, Dilated / Q000628:therapy; D002648:Child; D005260:Female; D016027:Heart Transplantation / Q000009:adverse effects*; D006353:Heart-Assist Devices / Q000009:adverse effects; D006470:Hemorrhage / Q000188:drug therapy*; D006801:Humans; D008751:Methylene Blue / Q000008:administration & dosage* / Q000627:therapeutic use; D059035:Perioperative Period; D056987:Vasoplegia / Q000188:drug therapy* / Q000209:etiology
chemical_list: D001779:Blood Coagulation Factors; C025667:prothrombin complex concentrates; D008751:Methylene Blue