Catastrophic Intracardiac Thrombosis During Emergency Repair of an Expanding Aortic Pseudoaneurysm: A Case Report

Abstract

Catastrophic thrombosis is a rare but frequently fatal event following complex cardiac surgery. It is most often encountered following separation from cardiopulmonary bypass (CPB) and reversal of heparin anticoagulation, and somewhat paradoxically, at the time when bleeding from post-CPB coagulopathy is being treated. We report the case of a 41-year-old female taken to the operating room for repair of an expanding ascending aortic pseudoaneurysm. Following a prolonged operation, she developed intracardiac thrombus during transfusion of hemostatic blood products and procoagulant agents. Potential contributing factors are discussed.

Figure.

The timeline represents the 357-min course of cardiopulmonary bypass. The blue line and right axis represent the ACTs obtained (s), and the red line and left axis represent the patient’s hemoglobin (g/dL). The red circles are the number of RBC units transfused. Platelet count is ×10³/μL, and fibrinogen level is mg/dL. ACT indicates activated clotting time; CPB, cardiopulmonary bypass; DHCA, deep hypothermic circulatory arrest (34 min); Fib, fibrinogen; Plt, platelet; RBC, red blood cell; UFH, unfractionated heparin.