[HSF] Aprotinin

[Steven Schwartz]

Probably coincidental to the Aprotinin.
Much more likely to be atheroemboli in a 77 yo with AS and multi- 
vessel CAD.
Check the path specimen.
Steven Schwartz

On Sep 20, 2007, at 9:20 AM, ebender001 at charter.net wrote:

> Two days ago I did an aortic valve, cabg on a 77 year old Jehovah's  
> Witness patient.  She had drug eluting stents placed two months  
> previously in the ramus and LAD.  She returned to the ER with an  
> MI, a 90% ostial and 70% mid LAD stenosis, 70% ramus stenosis, and  
> an aortic valve mean gradient of 50 mmHg.  Because of ongoing  
> ischemia, an intra-aortic balloon pump was placed in the cath lab,  
> resolving her chest pain and ST segment depression.  Her starting  
> hematocrit was 33.  She would not accept blood under any  
> circumstance.  The case went without a problem, and she had a post- 
> op hematocrit of 31.  She transferred out of the ICU on post-op day  
> 1 without any issues.  She developed shortness of breath and  
> abdominal distention with a drop in blood pressure that night.  The  
> bottom line is that she got a laparotomy this morning (post-op day  
> 3) and had a deat right colon removed.
>
> This is the only case in the last 10 years that I have used  
> aprotinin, and I am wondering about causation.  She had an episode  
> of atrial fib during the time she was developing shortness of  
> breath.  TEE during the heart surgery showed no left atrial clot.  
> The aortic annulus was not very calcified, requiring very little  
> debridement.  I know the etiology of the dead bowel is not  
> proveable, but I wonder about the effects of aprotinin.  Any comments?
>
> Ed Bender, MD
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