Related Experiment Videos
[Oxygenator thrombosis without heparin resistance].
1Service d'anesthésie-réanimation, hôpital Louis-Pradel, BP Lyon-Montchat, 69394 Lyon cedex 03, France. jean.jacques.lehot@chu-lyon.fr
Annales Francaises D'Anesthesie Et De Reanimation
|March 20, 2004
Summary
A patient with HIV and polycythemia vera experienced an issue with their oxygenator during bypass surgery. Microscopic examination revealed fibrin and platelet deposits, suggesting a potential cause for the malfunction.
Area of Science:
- Cardiovascular Surgery
- Hematology
- Biomaterials Science
Background:
- A 55-year-old male with Human Immunodeficiency Virus (HIV) and Polycythemia Vera underwent coronary artery bypass graft (CABG) surgery.
- The procedure utilized normothermic extracorporeal circulation, requiring anticoagulation with heparin.
Observation:
- Activated clotting time (ACT) was significantly elevated at 633 seconds post-heparinization.
- Unexpectedly low arterial and venous oxygen partial pressures were noted.
- High pressure (350 mmHg) was detected in the arterial line upstream of the oxygenator.
Findings:
- The oxygenator was replaced during surgery due to the observed abnormalities.
- Post-procedure, electronic microscopic examination revealed fibrin and platelet deposits on the oxygenator membrane and thermic exchanger.
- These deposits are hypothesized to be the cause of the oxygenator malfunction.
Implications:
- This case highlights a potential complication of extracorporeal circulation in patients with specific hematological conditions.
- Fibrin and platelet deposition can impair oxygenator function, necessitating prompt recognition and intervention.
- Further research may be warranted to optimize anticoagulation and circuit management in high-risk patients undergoing cardiopulmonary bypass.