Intracardiac Thrombosis and Acute Right Ventricular Failure Following Complex Reoperative Cardiac Surgery With Aprotinin and Deep Hypothermic Circulatory Arrest

Abstract

Although coagulopathy and bleeding are common in the setting of cardiac surgery, a growing number of case reports in the literature suggest that hypercoagulability may also result in significant morbidity and mortality. We present a case of apparent hypercoagulability with formation of thrombus in the cardiac chambers following reoperative cardiac surgery using cardiopulmonary bypass, aprotinin, and deep hypothermic arrest. A review of those hypercoagulable disorders with reported impact on cardiac surgery and a discussion follow the case presentation.

High mortality associated with intracardiac and intrapulmonary thromboses after cardiopulmonary bypass

“…Intraoperative transesophageal echocardiography (TEE) was used to document the location of thrombus in 19 cases described in 16 publications from 2001 to 2008 [20][21][22][23][26][27][28][29][30][31][32][33][34][35][36][37]. In 3 (15.8%) of 19 cases, thrombus formation was observed in right cardiac chambers and/or pulmonary arteries, leading to acute right ventricular failure.…”