A 32-year-old obese male with bicuspid aortic valve and severely dilated ascending
aorta (59.5 mm) underwent hemi-arch aortic replacement and valvuloplasty on cardiopulmonary
bypass. Due to progressive respiratory failure, veno-venous extracorporeal membrane
oxygenation (ECMO) was started on postoperative day 4. On postoperative day 15, ECMO
flow fell and the patient was progressively desaturating. Chest X-ray was normal.
Trans-Oesophageal echocardiography revealed a mobile thrombus in the right atrium (Fig. 1, Panel A, asterisk) passing the tricuspid valve toward the right ventricle during
systole (Supplementary video 1). Blood tests showed normal coagulation but low platelets (26,000/mm3 versus 160,000/mm3 at day 0). Following redo-sternotomy, a right atrial thrombus measuring 3 × 12 cm
(Fig. 1, Panel B, left, Supplementary video 2) was removed. Intra-operatively, a second thrombus measuring 1.5 × 10 cm was discovered
in the pulmonary artery and removed (Fig. 1, Panel B, right).
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References
- Heparin-induced thrombocytopenia.N Engl J Med. 2015; 373: 252-261
- Heparin-induced thrombocytopenia (HIT): identification and treatment pathways.Glob Cardiol Sci Pract. 2018; 2018: 15
Article info
Publication history
Published online: October 05, 2018
Accepted:
September 29,
2018
Received:
September 17,
2018
Identification
Copyright
© 2018 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.
