A Surgery Case of Heparin-Induced Thrombocytopenia as a Complication of Ventricular Septal Perforation after Acute Myocardial Infarction

Yuki Yoshioka＊	Ryusuke Suzuki＊	Tomoya Miyamoto＊
Kenta Uekihara＊	Takeshi Sakaguchi＊	Mai Matsukawa＊
Ryo Hirayama＊	Masamichi Nakajima＊

（Department of Cardiovascular Surgery, Japanese Red Cross Kumamoto Hospital＊, Kumamoto, Japan）

A 66-year-old man with an unknown medical history developed chest pain and a diagnosis of acute myocardial infarction（AMI）was given by his physician. Percutaneous coronary intervention was performed in the left anterior descending artery. Echocardiography revealed ventricular septal perforation（VSP);therefore, the patient was transferred to our hospital. After admission, his platelet count dropped rapidly during heparin administration, and left ventricular thrombosis and deep vein thrombosis were noted, raising a suspicion of heparin-induced thrombocytopenia（HIT). To establish cardiopulmonary bypass, argatroban alone was insufficient to prolong the Powered by Editorial Manager●R and ProduXion Manager●R from the Aries Systems Corporation activated clotting time（ACT);thus, nafamostat mesilate was also used for coronary artery bypass grafting and surgical repair of VSP. It took many hours to normalize the ACT, requiring re-exploration for excessive bleeding. On the 37th postoperative day, the patient was transferred to another hospital. We performed cardiac surgical procedures using argatroban in a patient who developed HIT during the course of VSP following AMI;however, we had difficulty in controlling the ACT. Since, to the best of our knowledge, there are no previous studies reporting surgical case of VSP complicated by HIT, we present this case with a review of the relevant literature.

 

Jpn. J. Cardiovasc. Surg. 46:305-310（2017）

Keywords：Heparin-induced thrombocytopenia;ventricular septal perforation;Argatroban;Nafamostat mesilate