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J Thorac Cardiovasc Surg 2001;122:1255-1256
© 2001 The American Association for Thoracic Surgery
Brief Communications |
From the Departments of Cardiovascular Surgerya and Emergency Medicine,b Saga Prefectural Hospital, Koseikan, Saga, Japan.
Received for publication March 21, 2001. Accepted for publication April 24, 2001. Address for reprints: Kojiro Furukawa, Department of Thoracic and Cardiovascular Surgery, Saga Medical School, 5-1-1 Nabeshima, Saga City 849-8501, Japan (E-mail: furukawk@post.saga-med.ac.jp).
The anticoagulant effect of heparin is dependent on the level of antithrombin III (AT III). Argatroban (Novastan; Mitsubishi Tokyo Chemical Corporation, Tokyo, Japan) is a unique synthetic direct thrombin inhibitor developed in Japan.
1 Argatroban requires no AT III to exert its antithrombin effect. 2,3 We used this drug as an anticoagulant during cardiopulmonary bypass (CPB) in a patient with AT III deficiency.
Clinical summary
A 44-year-old man was transferred to our hospital with shock and multiorgan failure on December 31, 1999. Laboratory studies of his blood revealed severe liver dysfunction probably due to fulminant hepatitis. Echocardiography revealed severe aortic regurgitation and vegetations on the aortic valve, and infective endocarditis was diagnosed. Continuous hemodialysis and filtration for renal failure were performed for 12 days and plasma exchange for hepatic failure was performed twice. Gradually, his general condition improved. Aortic valve replacement was scheduled for March 21, 2000. A preoperative echocardiogram showed that the left ventricular diameter was 67.0 mm during diastole and 43.3 mm during systole, and the left ventricular
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