Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0018799 (heart disease)
 34,133 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Heparin-induced thrombocytopenia is a widely recognized clinical disorder. The spectrum of disease ranges from clinically insignificant to severe thrombosis (heparin-induced thrombocytopenia with associated thrombosis). Overall, thrombosis occurs in approximately 33% of adults diagnosed with heparin-induced thrombocytopenia and has been associated with high morbidity and mortality rates. Diagnostic testing for this disorder is not standard in children with thrombocytopenia who are receiving heparin, despite the fact that children with congenital heart disease may be exposed to heparin frequently. There are few reported cases of heparin-induced thrombocytopenia with associated thrombosis in children; herein, we describe the cases of 2 children who developed this disorder after undergoing a Fontan operation.
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PMID:Heparin-induced thrombocytopenia with associated thrombosis in children after the Fontan operation: report of two cases. 1263 73

Since 1992, miniaturized pulsatile air-driven ventricular assist devices (VADs), "Berlin Heart," have been used at many institutions (36 cases in North America in 19 different institutions) for pediatric use. Heparin-induced thrombocytopenia (HIT II) is a significant complication rarely reported in the setting of adult VAD support; no similar report exists concerning pediatric VAD support. We report on a 13-month-old, 8.1 kg girl who required LVAD support for cardiogenic shock of unclear etiology. The patient had a history of multiple surgical repairs for correction of complex congenital heart disease consisting of a series of left heart obstructive lesions (Shone's complex). Despite aggressive ventilatory and inotropic support, the patient continued to deteriorate and subsequently required extracorporeal life support. After 7 days of conventional venoarterial extracorporeal membrane oxygenation, a 10 ml Berlin Heart VAD was implanted. After implantation, the patient developed persistent low-grade fever of unclear etiology, gradual thrombocytopenia, and deterioration of renal function. On postimplant day 10, the pump required replacement because of concerns about an inlet valve thrombus; the explanted device demonstrated a nearly occlusive clot not appreciable from external inspection. Simultaneously, HIT II was diagnosed as a result of hematology workup for persistent thrombocytopenia. We discuss the unique challenges posed by HIT II complicating pediatric VAD support and in relation to the heparin coating of the device.
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PMID:Heparin-induced thrombocytopenia complicating support by the Berlin Heart. 1634 Mar 75

Repeated exposure to unfractionated heparin is the rule in many congenital heart disease patients. Heparin-induced thrombocytopenia occurs in 1% to 3% of adult cardiac surgeries, and carries high thrombotic morbidity (38% to 81%) and mortality (approximately 28%). Although heparin-induced thrombocytopenia appears to be infrequent in pediatric patients, particularly neonates, our evolving experience suggests postcardiopulmonary bypass congenital heart disease patients may be at increased risk. Diagnostic and therapeutic challenges include frequency of thrombocytopenia after cardiopulmonary bypass, imperfect laboratory testing, lack of established dosing of alternative anticoagulants (such as argatroban and lepirudin), and increased anticoagulant-related bleeding in young children.
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PMID:Recognition and management of heparin-induced thrombocytopenia in pediatric cardiopulmonary bypass patients. 1673 Nov 3

Heparin-induced thrombocytopenia (HIT) is a well recognized and described immune phenomenon in adults. However, pediatric data on the incidence, treatment, and complications of HIT are limited. Despite the widespread use of heparin in pediatric patients and the repeated and sustained exposures to heparin in neonates and children with congenital heart disease, HIT has been infrequently recognized and under-reported in this population. HIT is an intensely procoagulant disorder and carries significant morbidity and mortality. In this case series, we describe HIT management with argatroban as alternative anticoagulation in 3 children requiring extracorporeal life support.
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PMID:Argatroban for anticoagulation in pediatric patients with heparin-induced thrombocytopenia requiring extracorporeal life support. 1741 71

Ventricular support in patients with end-stage heart failure can be achieved using intracorporeal left ventricular assist device (LVAD) or percutaneous ventricular assist device (pVAD) systems. Multiple efforts have been made to minimize procedure-associated complications. We present a case report of an off-pump insertion of a MicroMed DeBakey VAD after Tandem Heart support using a previous sternotomy incision. A 47-year-old woman with end-stage heart failure after coronary artery bypass graft revascularization was admitted for pharmacologic treatment. She developed multi-organ failure and a severe coagulopathy with thromboembolic complications. Heparin-induced thrombocytopenia (HIT) was suspected. A percutaneous Tandem Heart was placed, the patient's condition stabilized, and finally a MicroMed DeBakey Child VAD was implanted off-pump, re-opening a previous sternotomy incision. To avoid the need for heparinization in the light of HIT and severe coagulopathy, the LVAD implantation was performed under Tandem Heart support without cardiopulmonary bypass. The patient has been anti-coagulated with angiomax ever since. Critically ill patients with end-stage heart disease, multi-organ failure, severe coagulopathy and a previous median sternotomy can be bridged from a Tandem Heart to MicroMed DeBakey VAD without cardiopulmonary bypass using the previous incision, provided there are few adhesions and stable hemodynamic conditions.
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PMID:Off-pump exchange of short-term percutaneous ventricular assist device (VAD) to long-term implantable VAD in severe coagulopathy and multi-organ failure. 1844 27