Korean J Anesthesiol.  1996 Aug;31(2):269-274. 10.4097/kjae.1996.31.2.269.

Acute Pulmonary Hypertension Associated with Protamine Neutralization of Systemic Heparinization during Open Heart Surgery

• Hwang KS
• Cho MW

• KMID: 2237793
• DOI: http://doi.org/10.4097/kjae.1996.31.2.269

Abstract

Protamine sulfate, a strong polycationic polypeptide, combined with acidic heparin to form a neutral salt, eliminates the anticoagulating properties of heparin. Heparin reversal with protamine after cardiopulmonary bypass may complicate with adverse hemodynamic effects including systemic hypotension, decreased cardiac output, changes in systemic and pulmonary vascular resistances, anaphylaxis and noncardiogenic pulmonary edema. We recently observed a case of severe pulmonary vasoconstriction with right ventricular failure after protamine administration in 37-year-old woman with mitral stenosis who underwent mitral valvuloplasty. After uneventful termination of cardiopulmonary bypass, administration of protamine was associated with sudden elevation of pulmonary arterial pressure with profound right ventricular distension and systemic hypotension by which heparin-protamine reaction is suspected. After intravenous epinephrine infusion and cardiac massage, these changes were reversed. Although the mechanism of this protamine-heparin induced response is unclear, complement activation and thromboxane release may play a role in the development of pulmonary vasoconstriction.

Keyword

Blood heparin; protamine; Lung pulmonary hypertension

MeSH Terms

Adult
Anaphylaxis
Arterial Pressure
Cardiac Output
Cardiopulmonary Bypass
Complement Activation
Epinephrine
Female
Heart Massage
Heart*
Hemodynamics
Heparin*
Humans
Hypertension, Pulmonary*
Hypotension
Mitral Valve Stenosis
Protamines
Pulmonary Edema
Thoracic Surgery*
Vasoconstriction
Epinephrine
Heparin
Protamines