Turner Marissa A, Hallowell Theresa C
Emergency and Critical Care Department, Ocean State Veterinary Specialists, East Greenwich, Rhode Island, USA.
Vet Med Sci. 2025 Jul;11(4):e70445. doi: 10.1002/vms3.70445.
To describe successful management of a coagulopathy secondary to cardiopulmonary arrest (CPA) associated with pulmonary balloon valvuloplasty.
An 8-month-old male intact Chihuahua mix presented for a pulmonary balloon valvuloplasty. Echocardiogram showed severe valvular pulmonic stenosis with a pulmonic valve maximum pressure gradient (PV max ΔP) of 108.2 mmHg (PV max ΔP >20 mmHg is considered abnormal). Near the end of the procedure, after the balloon deflation, the patient experienced prolonged periods of sinus arrest with associated ventricular escape rhythm. This was followed by complete sinus arrest and asystole. Cardiopulmonary resuscitation (CPR) was initiated. After four CPR cycles, return of spontaneous circulation was achieved. The patient continued to have hypotension despite fluid resuscitation, requiring vasopressor therapy. Hemorrhagic abdominal effusion was identified. Coagulopathy was confirmed via prolonged blood clotting times and thrombocytopenia. Treatment was comprehensive, including transfusions of whole blood, packed red blood cells and fresh frozen plasma. During 4 days of postoperative hospitalisation, the patient showed improvement and was discharged. Upon rechecking 13 and 227 days after discharge, a repeated echocardiogram showed a >50% improvement of the PV max ΔP measured at 40 and 38.5 mmHg, respectively.
This is the first published veterinary case report describing the recognition and successful treatment of a consumptive coagulopathy and presumptive disseminated intravascular coagulation (DIC) following CPA during a balloon valvuloplasty procedure.
描述成功处理与肺动脉球囊瓣膜成形术相关的心搏骤停（CPA）继发的凝血病。
一只8个月大未绝育的吉娃娃混血雄性犬因肺动脉球囊瓣膜成形术就诊。超声心动图显示严重的瓣膜性肺动脉狭窄，肺动脉瓣最大压力阶差（PV max ΔP）为108.2 mmHg（PV max ΔP >20 mmHg被认为异常）。在手术接近尾声时，球囊放气后，病犬出现长时间的窦性停搏并伴有室性逸搏心律。随后出现完全性窦性停搏和心搏停止。开始进行心肺复苏（CPR）。经过4个CPR周期后，恢复了自主循环。尽管进行了液体复苏，病犬仍持续低血压，需要使用血管升压药治疗。发现有腹腔内出血性积液。通过延长的凝血时间和血小板减少症确诊为凝血病。治疗是综合性的，包括输注全血、浓缩红细胞和新鲜冰冻血浆。在术后住院的4天里，病犬情况好转并出院。出院后13天和227天复查时，重复超声心动图显示PV max ΔP分别改善>50%，测量值分别为40和38.5 mmHg。
这是第一份发表的兽医病例报告，描述了在球囊瓣膜成形术过程中CPA后消耗性凝血病和疑似弥散性血管内凝血（DIC）的识别与成功治疗。
