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Portal vein thrombosis after aortic valve replacement surgery in a patient with antithrombin III deficiency--case presentation.

Wang YQ, Chen QL, Zhu D, Dong L - J Cardiothorac Surg (2014)

Bottom Line: We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency.PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiac Surgery, West China Hospital, Sichuan University, No, 37, Guoxue Alley, Chengdu, Sichuan Province 610041, China. donglikn199@163.com.

ABSTRACT
We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency. PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported.

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Related in: MedlinePlus

Contrast enhanced CT confirmed portal vein thrombosis formation.
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Figure 2: Contrast enhanced CT confirmed portal vein thrombosis formation.

Mentions: This patient is then underwent open-heart aortic valve mechanical valve replacement under general anesthesia and cardiopulmonary bypass (CPB). Heparin resistance was noticed during CPB and resolved after administration of the fresh frozen plasma. He was extubated 24 hours after the procedure with stable hemodynamic status. Warfarin was administered orally for since 48 h after surgery to maintain the international normalized ratio (INR) at 1.5–2.0. In third postoperative day, patients developed pulmonary infection and increased body temperature with positive sputum culture of bacteria klebsiella pneumonia. Then after several days of intravenous antibiotics, his symptom relieved. On the fifth postoperative, edema in lower extremities was well as obvious ascites were noticed in this patients. Best side echocardiogram reveal normal mechanical valve function with LV ejection fraction 65%. Abdominal ultrasound revealed thrombosis in proximal portion of the portal vein with no blood flow signal as well as dilated distal branch of portal vein system (Figure 1). Contrast enhanced CT also confirmed portal vein thrombosis formation in this patient (Figure 2). Gastroscopy examination showed the obvious esophageal and gastric varices formation. Further coagulation screening text confirmed ATIII deficiency in this patient with only 30% of normal reference valve, this level still maintained 3 month after the surgery. Conservative treatment strategy was chosen for this patient including increased intensity of anti-coagulation (combining lower molecular heparin as well as oral warfarin) as well as endoscopic variceal ligation. Patient’s symptom gradually improved and repeated contrast enhanced CT scanning showed the formation of portal venous collateral circulation. This patients then underwent open abdominal thrombectomy 1 month after the cardiac procedure and recover well.


Portal vein thrombosis after aortic valve replacement surgery in a patient with antithrombin III deficiency--case presentation.

Wang YQ, Chen QL, Zhu D, Dong L - J Cardiothorac Surg (2014)

Contrast enhanced CT confirmed portal vein thrombosis formation.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4012710&req=5

Figure 2: Contrast enhanced CT confirmed portal vein thrombosis formation.
Mentions: This patient is then underwent open-heart aortic valve mechanical valve replacement under general anesthesia and cardiopulmonary bypass (CPB). Heparin resistance was noticed during CPB and resolved after administration of the fresh frozen plasma. He was extubated 24 hours after the procedure with stable hemodynamic status. Warfarin was administered orally for since 48 h after surgery to maintain the international normalized ratio (INR) at 1.5–2.0. In third postoperative day, patients developed pulmonary infection and increased body temperature with positive sputum culture of bacteria klebsiella pneumonia. Then after several days of intravenous antibiotics, his symptom relieved. On the fifth postoperative, edema in lower extremities was well as obvious ascites were noticed in this patients. Best side echocardiogram reveal normal mechanical valve function with LV ejection fraction 65%. Abdominal ultrasound revealed thrombosis in proximal portion of the portal vein with no blood flow signal as well as dilated distal branch of portal vein system (Figure 1). Contrast enhanced CT also confirmed portal vein thrombosis formation in this patient (Figure 2). Gastroscopy examination showed the obvious esophageal and gastric varices formation. Further coagulation screening text confirmed ATIII deficiency in this patient with only 30% of normal reference valve, this level still maintained 3 month after the surgery. Conservative treatment strategy was chosen for this patient including increased intensity of anti-coagulation (combining lower molecular heparin as well as oral warfarin) as well as endoscopic variceal ligation. Patient’s symptom gradually improved and repeated contrast enhanced CT scanning showed the formation of portal venous collateral circulation. This patients then underwent open abdominal thrombectomy 1 month after the cardiac procedure and recover well.

Bottom Line: We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency.PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Cardiac Surgery, West China Hospital, Sichuan University, No, 37, Guoxue Alley, Chengdu, Sichuan Province 610041, China. donglikn199@163.com.

ABSTRACT
We presented an unique case of portal vein thrombosis (PVT) after aortic valve replacement due to antithrombin III (ATIII) deficiency. PVT after aortic valve replacement (AVR) is a serious complication, which has not previously been reported.

Show MeSH
Related in: MedlinePlus