Coagulation assessments were monitored before and 1 h after the dose of rFVIIa. of the early administration of abciximab. Case presentation A 53-year-old Japanese woman with chronic hypertension, who was on holiday in our town, presented to the emergency room of our hospital complaining of the sudden onset of severe chest pain radiating to her back. She experienced a blood pressure of 90/70 mm Hg and heart rate of 70 bpm. The ECG showed a marked ST-segment elevation in prospects II, III and aVF and a reciprocal ST-segment depressive disorder in V2 through V4 precordial prospects suggesting Rabbit polyclonal to Prohibitin an inferior wall AMI (physique 24, 25-Dihydroxy VD2 1). Because of the fast decline of the haemodynamic parameters neither a chest x-ray film nor transthoracic echocardiogram was performed. In the emergency room, the patient received oral aspirin 250 mg, ranitidine 50 mg intravenously, heparin 4.000 UI and an intravenous bolus of abciximab (Reopro, Eli Lilly, Indianapolis, IN, USA) 0.25 mg/kg body weight, and she was immediately transferred to our cath lab for any primary percutaneous coronary intervention (PCI). The angiogram, carried out through the right femoral artery, showed a slow anterograde filling of the left coronary artery, without any atherosclerotic narrowing, and a significant stenosis around the first tract of the right coronary artery (physique 2). An intracoronary dose of nitroglycerine (100 g) was injected to exclude a catheter-induced spasm. Thus, the operator decided to perform a main PCI by crossing the lesion with a guide-wire. Open in a separate window Physique 1 ECG showing a marked ST-segment elevation in prospects II, III and aVF and a reciprocal ST-segment depressive disorder in V2 through V4 precordial prospects. Open in a separate window Physique 2 Injection in the right coronary artery showing a critical obstruction in the first tract of the vessel. Surprisingly, the stenosis disappeared when the balloon-catheter (Sapphire, OrbusNeich, Hong Kong, China) was placed at the site of the lesion without inflation (physique 3). The operator then pulled back the catheter just outside the right coronary ostium and performed an injection, which exhibited the passage of contrast into the left ventricle and a clear dilatation of the aortic root (physique 4). The following aortogram showed an aortic dissection (Stanford type A) with secondary compression and torsion of the right coronary artery and epiaortic vessels and severe aortic regurgitation (physique 5). The patient was treated with intravenous infusion of plasma-expander and dopamine and she was brought to cardiac surgery for an emergency intervention. At the thoracic opening the heart appeared to be constricted by a massive pericardial blood shedding and the aortic wall was stuffed. The doctor carried out the aortic root replacement 24, 25-Dihydroxy VD2 with the implantation of a biological Freestyle (Medtronic Inc, Minneapolis, MN, USA) aortic prosthesis n 23 (full root technique) and the interposition of an InterVascular (Montvale, New Jersey, USA) prosthetic tube n 22. The patient received red blood cell (3 U) and new frozen plasma (5 U) transfusion at the end of cardiopulmonary bypass (CPB). Due to the relevant bleeding, 10 models of platelets were also given. Since bleeding was still uncontrolled, a dose of rFVIIa 70 mcg/kg was administered as an intravenous bolus. A second 24, 25-Dihydroxy VD2 dose was administered after 1 h to reduce blood loss to 150 ml/h. Coagulation assessments were monitored before and 1 h after the dose of rFVIIa. The postoperative course was regular and the CT exhibited a good result of the intervention and the presence of a residual flap of dissection involving the descending aorta with involvement of the superior pole of the left kidney. Because 24, 25-Dihydroxy VD2 of the good condition of the patient and the preservation of the renal function no further step was taken. Apart from a pericardial effusion in the eleventh postoperative day, which required drainage, the patient made an excellent recovery and was discharged 18 days after the operation. Open in a separate window Physique 3 Attempt of percutaneous coronary intervention: the obstruction disappears.