Medizinische Universität Graz Austria/Österreich - Forschungsportal - Medical University of Graz
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SHR Neuro Krebs Kardio Lipid Stoffw Microb
Daliakopoulos, SI; Schaedel, M; Klimatsidas, MN; Spiliopoulos, S; Koerfer, R; Tenderich, G.
Intra-abdominal hypertension due to heparin - induced retroperitoneal hematoma in patients with ventricle assist devices: report of four cases and review of the literature.
J Cardiothorac Surg. 2010; 5(3):108-108
Doi: 10.1186/1749-8090-5-108
(- Case Report)
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- Co-Autor*innen der Med Uni Graz
- Spiliopoulos Sotirios
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- Abstract:
- Elevated intra-abdominal pressure (IAP) has been identified as a cascade of pathophysiologic changes leading in end-organ failure due to decreasing compliance of the abdomen and the development of abdomen compartment syndrome (ACS). Spontaneous retroperitoneal hematoma (SRH) is a rare clinical entity seen almost exclusively in association with anticoagulation states, coagulopathies and hemodialysis; that may cause ACS among patients in the intensive care unit (ICU) and if treated inappropriately represents a high mortality rate. We report four patients (a 36-year-old Caucasian female, a 59-year-old White-Asian male, a 64-year-old Caucasian female and a 61-year-old Caucasian female) that developed an intra-abdominal hypertension due to heparin-induced retroperitoneal hematomas after implantation of ventricular assist devices because of heart failure. Three of the patients presented with dyspnea at rest, fatigue, pleura effusions in chest XR and increased heart rate although b-blocker therapy. A 36-year old female (the forth patient) presented with sudden, severe shortness of breath at rest, 10 days after an "acute bronchitis". At the time of the event in all cases international normalized ratio (INR) was <3.5 and partial thromboplastin time <65 sec. The patients were treated surgically, the large hematomas were evacuated and the systemic manifestations of the syndrome were reversed. Identifying patients in the ICU at risk for developing ACS with constant surveillance can lead to prevention. ACS is the natural progression of pressure-induced end-organ changes and develops if IAP is not recognized and treated in a timely manner. Failure to recognize and appropriately treat ACS is fatal while timely intervention - if indicated - is associated with improvements in organ function and patient survival. Means for surgical decision making are based on clinical indicators of adverse physiology, rather than on a single measured parameter.
- Find related publications in this database (using NLM MeSH Indexing)
- Abdomen -
- Adult -
- Anticoagulants - adverse effects
- Compartment Syndromes - chemically induced Compartment Syndromes - radiography Compartment Syndromes - therapy
- Female -
- Heart-Assist Devices -
- Hematoma - chemically induced Hematoma - radiography
- Heparin - adverse effects
- Humans -
- Male -
- Middle Aged -
- Radiography, Abdominal -
- Retroperitoneal Space - radiography