Left Ventricular Perforation during Catheter Ablation in a Patient with Idiopathic Thrombocytopenic Purpura
DOI:
https://doi.org/10.1532/hsf.1484Abstract
Preoperative gamma-globulin therapy was recently performed to prevent bleeding complications in a patient with concomitant idiopathic thrombocytopenic purpura undergoing cardiac surgery. Here we report the case of a 75-year-old male patient with idiopathic thrombocytopenic purpura, chronic aortic dissection, and funnel chest in whom a left ventricular perforation sustained during catheter ablation was repaired during emergent surgery. Despite preoperative gamma-globulin therapy not being performed, bleeding complications were prevented because platelets were preserved by avoidance of cardiopulmonary bypass use. Although the funnel chest made it difficult to secure the operative field, the deep pericardial sutures were effective in repairing the perforation without cardiopulmonary bypass.References
Imbach P, Barandun S, d’Apuzzo V, et al. 1981. High-dose intravenous gammaglobulin for idiopathic thrombocytopenic purpura in childhood. Lancet 6:1228-31.
Mathew TC, Vasudevan R, Leb L, Pezzella SM, Pezzella AT. 1997. Coronary artery bypass grafting in immune thrombocytopenic purpura. Ann Thorac Surg 64:1059-62.
Marumoto A, Ashida Y, Kuroda H, et al. 2005. Mitral valve repair for mitral insufficiency due to infective endocarditis in a patient with idiopathic thrombocytopenic purpura. Ann Thorac Cardiovasc Surg 11:48-50.
Tokuda M, Kojodjojo P, Epstein LM, et al. 2011. Outcomes of cardiac perforation complicating catheter ablation of ventricular arrhythmias. Circ Arrhythm Electrophysiol 4:660-6.
Uchida N, Katayama A, Tamura K, Sutoh M, Kuraoka M, Sueda T. 2012. New approach for extended thoracic aortic repair: anterolateral thoracotomy with partial sternotomy. Ann Thorac Cardiovasc Surg 18:395-9.