Left atrial thrombus in a 10-month-old boy ? successful thrombolysis with recombinant tissue-type plasminogen activator after open-heart surgery: review of the literature

1996 ◽  
Vol 22 (9) ◽  
pp. 968-971
Author(s):  
H. G. Kehl ◽  
D. Kececioglu ◽  
H. Vielhaber ◽  
S. Kotthoff ◽  
M. Weyand ◽  
...  
Keyword(s):  
Left Atrial ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Tissue Type ◽  
Open Heart ◽  
Review Of The Literature ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Type Plasminogen Activator ◽  
Successful Thrombolysis

PHYSIOLOGICAL ROLE OF THE ENHANCED FIBRINOLYTIC ACTIVITY DURING CARDIOPULMONARY BYPASS IN OPEN HEART SURGERY

1987 ◽  
Author(s):  
Y Kanamori ◽  
I Yada ◽  
I Yuasa ◽  
M Kusagawa ◽  
K Deguchi
Keyword(s):  
Cardiopulmonary Bypass ◽  
Fibrinolytic Activity ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Physiological Role ◽  
Maximum Level ◽  
Tissue Type ◽  
Bleeding Complications ◽  
Open Heart ◽  
Type Plasminogen Activator

Fibrinolytic activity is reportedly increased during cardiopulmonary bypass( CPB ), and this increase has been considered to be related to the bleeding complications in open heart surgery. The purpose of this study was to clarify the nature of the fibrinolytic activity duringCPB. Twenty patients with valve replacement or aortocoronary bypass surgery were examined. The following parameters were determined: fibrinogen, plasminogen, fibrinopeptide A( FPA ), fibrinopeptide B β 15-42 ( FPB β15-42 ), and tissue-type plasminogen activator ( t-PA ). For further characterization of the fibrinolytic activity, the fibrin plate method was used. Intrinsic fibrinolytic activity was determined by the assay of the fibrinolytic activity of the kaolin activatedeuglobulin. Extrinsic fibrinolyticactivity was estimated by the assayof Cl-inactivator resistant fibrinolytic activity as well as t-PA. Fibrinogen and plasminogen did not decrease except at the beginning of CPB. FPA was increased significantly during CPB. FPB3 15-42 was also increased to four times the preoperative value at 2 hrs of CPB. The intrinsic fibrinolytic system was activatedonly a short time after the startof CPB. The Cl-inactivator resistant fibrinolytic activity was activated gradually during CPB, reached a maximum level 1 hr after the start of CPB, and returned to the preoperative level within 1 hr after the end of CPB. The changes on t-PA paralleled the course of the Cl-inactivator resistant fibrinolytic activity, indicating that enhanced fibrinolytic activity during CPB is predominantly of extrinsic origin caused by t-PA. We conclude that thrombin activity continues during CPB despite the use of heparin, and thatthe enhanced fibrinolytic activity during CPB is essential because t-PA activates plasminogen predominantly at the sites where fibrin is formed, resulting in the dissolution of the microthrombi formed during CPB.

Application of Cerebral Protection System in Open Mitral Replacement with Extensive Calcified Left Atrial Thrombus

2019 ◽  
Vol 15 (1) ◽  
pp. 85-87
Author(s):  
Jacky Y.K. Ho ◽  
Joyce W.Y. Chan ◽  
Simon C.Y. Chow ◽  
Peter S.Y. Yu ◽  
Micky W.T. Kwok ◽  
...  
Keyword(s):  
Left Atrial ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Neurological Complications ◽  
Cerebral Protection ◽  
Protection System ◽  
Left Atrial Thrombus ◽  
Atrial Thrombus ◽  
Risk Patients ◽  
Neurological Protection

Neurological complications remain a major burden in cardiac surgery, despite various intraoperative measures attempting to reduce its occurrence. Advancement of percutaneous approach in valve replacement has brought focus to the use of cerebral protection system (CPS). We reported a novel application of percutaneous CPS in open heart surgery for a patient with an extensive calcified left atrial thrombus to reduce risk of embolic stroke. Although, there is no evidence to advocate routine use of CPS in all open cardiac surgical patients, we believe it is a technically feasible and probably safe approach for neurological protection in high-risk patients.

Enhanced Effective Fibrinolysis following the Neutralization of Heparin in Open Heart Surgery Increases the Risk of Post-Surgical Bleeding

1990 ◽  
Vol 63 (02) ◽  
pp. 241-245 ◽  
Author(s):  
Jørgen Gram ◽  
Thomas Janetzko ◽  
Jørgen Jespersen ◽  
Hans Dietrich Bruhn
Keyword(s):  
Blood Loss ◽  
Plasminogen Activator ◽  
Heart Surgery ◽  
Degradation Products ◽  
Open Heart Surgery ◽  
Tissue Type ◽  
Tissue Type Plasminogen Activator ◽  
Type Plasminogen Activator ◽  
Chest Tube Drain ◽  
Median Blood Loss

SummaryThe tissue-type plasminogen activator related fibrinolytic system was studied in 24 patients undergoing cardiopulmonary bypass surgery. The degradation of fibrinogen and fibrin was followed during and after surgery by means of new sensitive and specific assays and the changes were related to the blood loss measured in the chest tube drain during the first 24 postoperative hours. Although tissue-type plasminogen activator was significantly released into the circulation during the period of extracor-poreal circulation (p <0.01), constantly low levels of fibrinogen degradation products indicated that a systemic generation of plasmin could be controlled by the naturally occurring inhibitors. Following extracorporeal circulation heparin was neutralized by protamine chloride, and in relation to the subsequent generation of fibrin, there was a short period with increased concentrations of fibrinogen degradation products (p <0.01) and a prolonged period of degradation of cross-linked fibrin, as detected by increased concentrations of D-Dimer until 24 h after surgery (p <0.01). Patients with a higher than the median blood loss (520 ml) in the chest tube drain had a significantly higher increase of D-Dimer than patients with a lower than the median blood loss (p <0.05).We conclude that the incorporation of tissue-type plasminogen activator into fibrin and the in situ activation of plasminogen enhance local fibrinolysis, thereby increasing the risk of bleeding in patients undergoing open heart surgery

scholarly journals Perioperative Results from Left Atrial Appendage Removal during Open Heart Surgery

2017 ◽  
Vol 65 (S 01) ◽  
pp. S1-S110
Author(s):  
C. Bening ◽  
K. Hamouda ◽  
M. Leistner ◽  
D. Radakovic ◽  
M. Oezkur ◽  
...  
Keyword(s):  
Left Atrial ◽  
Heart Surgery ◽  
Left Atrial Appendage ◽  
Open Heart Surgery ◽  
Atrial Appendage ◽  
Open Heart

scholarly journals A novel case of impaired C-reactive protein response following open-heart surgery: a case report and review of the literature

2021 ◽  
Author(s):  
Erik Wilhelm Vinnes ◽  
Paul Kjetel Soldal Lillemoen ◽  
Robert Matongo Persson ◽  
Klaus Meyer ◽  
Rune Haaverstad ◽  
...  
Keyword(s):  
Case Report ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
Review Of The Literature ◽  
C Reactive Protein ◽  
Reactive Protein ◽  
Protein Response

scholarly journals Large Right Atrial Thrombus Associated with Central Venous Catheter Requiring Open Heart Surgery

2012 ◽  
Vol 2012 ◽  
pp. 1-4 ◽  
Author(s):  
Nasir Hussain ◽  
Paul Eric Shattuck ◽  
Mourad Hussein Senussi ◽  
Erwin Velasquez Kho ◽  
Mubeenkhan Mohammedabdul ◽  
...  
Keyword(s):  
Heart Surgery ◽  
Treatment Guidelines ◽  
Preoperative Evaluation ◽  
Open Heart Surgery ◽  
Interesting Case ◽  
Right Atrial ◽  
Open Heart ◽  
Central Venous ◽  
Atrial Thrombus ◽  
Right Atrial Thrombus

Central venous catheters (CVC) are used commonly in clinical practice. Incidences of CVC-related right atrial thrombosis (CRAT) are variable, but, when right atrial thrombus is present, it carries a mortality risk of 18% in hemodialysis patients and greater than 40% risk in nonhemodialysis patients. Different pathogenic mechanisms have been postulated for the development of CRAT, which includes mechanical irritation of the myocardial wall, propagation of intraluminal clot, hypercoagulability, and hemodynamics of right atria. Presentation of CRAT may be asymptomatic or may be associated with one of the complications of CRAT like pulmonary embolism, systemic embolism, infected thrombi, or hemodynamic compromise. There are no established treatment guidelines for CRAT. We describe an interesting case of a 59-year-old asymptomatic male successfully treated with open heart surgery after failure of medical treatment for a large CRAT discovered during a preoperative evaluation for a kidney transplant. Our case underscores that early detection of CRAT may carry a favorable prognosis as opposed to waiting until catastrophic complications arise. It also underscores the importance of transesophageal echocardiography in the detection of thrombus and perhaps guides clinicians on which treatment modality to be used according to the size of the thrombus.

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