Suicide left ventricle following protamine: A case report

Area of Science:

• Cardiology
• Anesthesiology
• Cardiac Surgery

Background:

• Severe aortic stenosis and left ventricular hypertrophy necessitate advanced interventions.
• Transcatheter aortic valve replacement (TAVR) is a critical procedure for high-risk patients.
• Protamine sulfate is used to reverse heparin anticoagulation post-cardiac procedures.

Observation:

• A patient undergoing TAVR experienced a sudden and significant drop in blood pressure.
• This hemodynamic instability occurred shortly after the administration of protamine sulfate.
• The event was diagnosed as a protamine reaction, specifically a vasoplegic syndrome.

Findings:

• Protamine reactions can cause severe hypotension and cardiovascular compromise.
• Prompt recognition and management of protamine-induced hypotension are crucial for patient outcomes.
• This case underscores the potential for severe adverse events even with standard TAVR protocols.

Implications:

• Clinicians should consider slow, careful administration of protamine sulfate.
• Continuous hemodynamic monitoring is essential during and after protamine administration in TAVR patients.
• Awareness of protamine reactions can guide timely and effective interventions, improving patient safety in cardiac surgery.