Treatment of hemopericardium caused by mitral balloon valvuloplasty with activated factor VII: a case report

Journal of Medical Case Reports

Iosif Gulkarov²  Berhane Worku²  Igor Mamkin³  Jeremy Steele¹ 

[1] Department of Pediatrics, SUNY Upstate Medical University Center, Golisano Children’s Hospital, 750 East Adams Street, Syracuse, NY 13210, USA;Department of Cardiothoracic Surgery, New York Methodist Hospital, 506 Sixth Street, Miner 3, Brooklyn, NY 11215, USA;Division of Cardiology New York Methodist Hospital, 506 Sixth Street, Miner 3, Brooklyn, NY 11215, USA

关键词: Mitral balloon valvuloplasty;    Mediastinal bleeding;    Hemopericardium;    Factor VIIa;    Complications and management;   

Others  :  822838
DOI  :  10.1186/1752-1947-8-33

 received in 2013-03-29, accepted in 2013-11-25,  发布年份 2014

【 摘 要 】

Introduction

The use of mitral balloon valvuloplasty as a percutaneous intervention for mitral stenosis has been shown to be efficacious. Cardiac tamponade is a rare but serious complication of this procedure. Despite the low incidence of this event, cardiac tamponade is well-reported in the literature. The management strategy of this complication involves pericardial drainage and correction of coagulopathy, followed by surgical exploration if these interventions fail. With this case report, we demonstrate the successful application of activated factor VII in the management of bleeding after balloon valvuloplasty that persisted despite the standard treatments described above.

Case presentation

Our patient was a 31-year-old Yemenite man with no significant past medical history, who presented with progressively worsening dyspnea on exertion and limited functional capacity over the last few years. A transesophageal echocardiogram revealed severe mitral stenosis, which was treated with a mitral valve valvuloplasty. The procedure was complicated by significant mediastinal bleeding that did not respond to routine maneuvers, which included pericardiocentesis and correction of coagulopathy. Our patient was evaluated for surgical intervention but responded to treatment with activated factor VII.

Conclusion

Factor VII may be used in the treatment of refractory mediastinal bleeding secondary to mitral valvuloplasty prior to attempting surgical repair, and therefore may spare the patient the morbidity associated with surgery.

【 授权许可】

   
2014 Steele et al.; licensee BioMed Central Ltd.

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