We report a case of a 77-year-old woman with massive pulmonary embolism associated with heparin-induced thrombocytopenia. Before developing a pulmonary embolism, the patient underwent gastrectomy due to gastric cancer and received subcutaneous heparin calcium for deep venous thrombosis prophylaxis for 5 d. Then, thrombectomy with cardiopulmonary bypass using full heparinization was successfully performed. The patient was definitively diagnosed with this condition postoperatively, based on elevated serum antibody levels, in addition to pre-and postoperative thrombocytopenia and thrombosis. Intravenous heparin therapy was switched to argatroban. Although it is uncommon, clinicians should consider this condition in patients with a history of heparin exposure.
An 81-year-old man with multiple comorbidities developed infected thoracic aortic aneurysm, and we employed a strategic two-step surgical approach combining thoracic endovascular aortic repair and local debridement with an omental flap during the active phase of infection. No signs of reinfection were observed at the 1-year follow-up. This strategy can be a safe and less invasive alternative to conventional open surgery in patients with high surgical risk.
Background
Left ventricular free wall rupture is one of the most lethal complications of myocardial infarction and can cause catastrophic cardiac tamponade. Extracorporeal membrane oxygenation (ECMO) is often used to treat hemodynamic instability due to cardiac tamponade. However, elevated pericardial pressure collapses the right atrium, resulting in inadequate ECMO access and preventing stabilization of the circulation. Further, it interferes with the venous return from the superior vena cava (SVC), which increases the intracranial pressure and reduces cerebral perfusion levels.
Case presentation:
A 65-year-old man was hospitalized for out-of-hospital cardiac arrest. We used ECMO for cardiopulmonary resuscitation. After the establishment of ECMO, transthoracic echocardiography and left ventriculography revealed massive pericardial effusion. The treatment was supplemented with pericardial drainage since ECMO failed frequently in providing adequate suction. However, the blowout rupture caused the requirement of constant drainage from the pericardial catheter. Herein, we connected the venous cannula of ECMO and pericardial drainage catheter. The surgery was performed with stable circulation without the suction failure of ECMO.
Conclusion
We present a case wherein the combination of pericardial drainage and ECMO was used to maintain circulation in a patient with massive pericardial effusion due to cardiac rupture.
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