Skip to main content Skip to main navigation menu Skip to site footer

Multiple re-exploration due to excessive bleeding due to coagulopathy after aortic valve replacement in patients with chronic asymptomatic hepatitis B infection: A case report

  • Rindu Anggara Parulian Napitupulu ,
  • Ratna Farida Soenarto ,
  • Aldy Heriwardito ,

Abstract

Link Of Video Abstract: https://youtu.be/RelpPxOynWw

 

Background: Postoperative bleeding following cardiac surgery represents a recognized and significant complication, particularly in patients with asymptomatic hepatitis B infection who have undergone open-heart procedures with a cardiopulmonary bypass machine (CPB). Patients requiring re-exploration due to bleeding face elevated mortality risks due to detrimental factors associated with the procedure, such as bleeding, transfusions, hypoperfusion resulting from cardiac tamponade or blood loss, multiple organ ischemia, and organ failure. The aim of this article is to discuss perioperative preparations specific to cases of patients with chronic hepatitis B undergoing open-heart surgery.

Case Presentation: This case study revolves around a 53-year-old Asian male who had been slated for aortic valve replacement. Transthoracic echocardiography (TTE) uncovered severe aortic regurgitation with vegetation at the non-coronary cusp (NCC) and right coronary cusp (RCC), accompanied by chamber dilatation. The patient was under Tenofovir therapy for his chronic yet asymptomatic hepatitis B infection. The surgical procedure utilized a cardiopulmonary bypass machine (CPB), but multiple re-explorations were necessitated due to excessive bleeding attributed to post-surgery coagulopathy.

Conclusion: Postoperative bleeding following cardiac surgery represents a widely recognized and serious complication, particularly in patients with asymptomatic hepatitis B infection who have undergone open-heart procedures with CPB. CPB has been extensively documented to stimulate the generation and release of various vasoactive substances and cytotoxic mediators, disrupting "rebalanced hemostasis" and leading to coagulopathy.

References

  1. Elassal AA, Al-Ebrahim KE, Debis RS, Ragab ES, Faden MS, Fatani MA, et al. Re-exploration for bleeding after cardiac surgery: revaluation of urgency and factors promoting low-rate. Journal of Cardiothoracic Surgery. 2021; 16:166-77.
  2. Sharma D, Sisodia A, Devgarha S, Mathur M. Evaluation of early post-operative complications after open heart surgery in Hepatitis B positive patients. Heart India. 2016;4(2):18-22.
  3. Dangana A, Peter A, Onoja SO, Haruna AS, Baamlong N, Ali PO, et al. Coagulation profiles of patients with chronic liver disease. Saudi J Med. 2023;8(3):67-73.
  4. Kujovich JL. Coagulopathy in liver disease: a balancing act. Hematology Am Soc Hematol Educ Program. 2015;2015:243-9.
  5. An Y, Xiao YB, Zhong QJ. Open-heart surgery in a patient with liver cirrhosis: indications, risk factors, and clinical outcomes. Eur Surg Res 2007;39(2):67-74.
  6. Paparela D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update Eur J Cardiothorac Surg. 2002; 21(2):232-44.
  7. Wang Z et al. Planned reoperation after cardiac surgery in the cardiac intensive care unit. Reviews Cardiovascular Medicine. 2023; 24(3): 87 -95.
  8. Ul Islam M, Ahmad I, Khan B, Jan A, Ali N, Hassan Khan W, Farooq O, Khan H, Ahmad Ali F, Shahid M. Early chest re-exploration for excessive bleeding in post cardiac surgery patients: does it matter? Cureus. 2021 May 18;13(5):e15091.
  9. Bolliger D, Mauermann E. Re-exploration after cardiac surgery impairs outcome-but how to stratify the risk? Editorial. Journal of Cardiothoracic and Vascular Anesthesia. 2019;33: 2938-40
  10. Tirilomis T, Bougioukas IG, Friedrich MG, Danner BC, Schoendube FA. Re-exploration early after cardiac surgery in adults: The importance of bleeding-related complications. Heart Surg Forum. 2020;23(2):E174-7.
  11. Sniecinski RM, Levy JH. Bleeding and management of coagulopathy. J. Thorac Cardiovasc surgery. 2011;142:662-7.
  12. Chee YE, Liu SE, Irwin MG. Management of bleeding in vascular surgery. British Journal of Anaesthesia. 2016;117(2): 85-94.
  13. Stravitz RT. Potential Application of thromboelastography in patient with acute and chronic liver disease. Gastroenterology and hepatology. 2012;8(8):513-20.

How to Cite

Napitupulu, R. A. P., Soenarto , R. F. ., & Heriwardito, A. . (2024). Multiple re-exploration due to excessive bleeding due to coagulopathy after aortic valve replacement in patients with chronic asymptomatic hepatitis B infection: A case report. Bali Medical Journal, 13(1), 390–393. https://doi.org/10.15562/bmj.v13i1.4911

HTML
7

Total
3

Share

Search Panel

Rindu Anggara Parulian Napitupulu
Google Scholar
Pubmed
BMJ Journal


Ratna Farida Soenarto
Google Scholar
Pubmed
BMJ Journal


Aldy Heriwardito
Google Scholar
Pubmed
BMJ Journal