to post procedural transfusion were heart failure, diabetes and peripheral arterial disease. Increase INR level and activated partial thromboplastin time (aPTT) are both significantly correlated to complication development (p<0.05). The types of medications that are significantly correlated to post procedural transfusion included Unfractionated Heparin (p=0.009), Clopidogrel (p=0.041) and GP2B3A inhibitor (p=0.039). Prasugrel (p=0.001) and Bivalirudin were the only medications that significantly did not show an increase in the need for transfusion. The antiplatelet Aspirin (p>0.05) and low molecular weight (LMW) Heparin (p>0.05) were the only medications that did not show significant correlation to bleeding and transfusion. Conclusions: Practitioners should take into consideration the patient's age ≥70, female sex, low BMI, coagulation status (elevated INR and aPTT level) and concomitant use of anticoagulant as a basis when prescribing anticoagulant therapy among patients undergoing cardiac interventional procedures
We present a case of delayed diagnosis of traumatic tricuspid valve rupture in a patient who was emergently brought to the operating room for repair of lacerations to the heart and liver without intraoperative transesophageal echocardiography (TEE). Initial postoperative transthoracic echocardiography (TTE) did not show structural pathology. One week later, TTE with better image quality showed severe tricuspid regurgitation. Subsequently, TEE clearly demonstrated rupture of the anterior papillary muscle and flail anterior tricuspid leaflet. The case description is followed by a brief discussion of the utility of TEE in the setting of blunt thoracic trauma.
Background We report the first ante-mortem diagnosis of hemorrhagic pericardial effusion in hereditary hemorrhagic telangiectasia resulting in constriction; the case also demonstrates the unusual but well-described complication of right-sided heart failure requiring extracorporeal membrane oxygenation (ECMO) support after pericardiectomy. Case presentation A previously healthy 48 year old man with a strong family history of Osler–Weber–Rendu disease presented to our institution with signs and symptoms of advance heart failure. His workup demonstrated a thickened pericardium and constrictive physiology. He was brought to the operating room where old clot and inflamed tissue were appreciated in the pericardial space and he underwent complete pericardiectomy under cardiopulmonary bypass. Separation from bypass, hampered by the development of right ventricular dysfunction and profound vasoplegia, required significant pressor and inotropic support. The right heart dysfunction and vasoplegia worsened in the early postoperative period requiring a week of ECMO after which his right ventricle recovered and he was successfully de-cannulated. Conclusion Given the poor outcome of severe postoperative right ventricular failure after pericardiectomy, with high central venous pressure, a low gradient between central venous and pulmonary artery pressures and high vasopressor requirements, ECMO should be instituted promptly.
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