RESUMO
Bronchovenous fistula is occasionally encountered after traumatic lung injury or, in neonates, due to ventilation injuries with high ventilatory pressures. We report a case of massive air embolism associated with a bronchopulmonary venous communication in an infant post-repair of truncus arteriosus. Selective ventilation of the opposite lung for 3 days sealed the fistula.
Assuntos
Fístula Brônquica/terapia , Ponte Cardiopulmonar/efeitos adversos , Veias Pulmonares , Fístula Vascular/terapia , Fístula Brônquica/etiologia , Embolia Aérea/etiologia , Embolia Aérea/terapia , Humanos , Lactente , Recém-Nascido , Respiração Artificial , Persistência do Tronco Arterial/cirurgia , Fístula Vascular/etiologiaRESUMO
UNLABELLED: We treated persistent hemorrhage after cardiopulmonary bypass in a heart transplant recipient who had received anticoagulation with the direct thrombin inhibitor bivalirudin by a combination therapy aimed at reducing the plasma concentration of the thrombin antagonist (hemodialysis and modified ultrafiltration), increasing the concentration of thrombin at bleeding sites (recombinant factor VIIa), and increasing the plasma concentration of other coagulation factors (fresh frozen plasma and cryoprecipitate). The bleeding was controlled, and there was no thrombotic complication. IMPLICATIONS: A combination of modified ultrafiltration, hemodialysis, and the administration of recombinant factor VIIa, fresh frozen plasma, and cryoprecipitate may reverse the anticoagulant effect of bivalirudin.