122 T . Takeichi et al .: J Extra Corpor Technol 2024 , 56 , 120 – 124
Figure
2 . The figure after entering the ICU course . Sys ABP .: Systolic arterial blood pressure ; Sys PAP .: Systolic pulmonary artery pressure ; mean CVP .: Mean central venous pressure ; SvO 2 .: Heart rate ; HR .: Mixed venous oxygen saturation ; CI .: Cardiac index ; iNO .: Inhaled nitric oxide .
Figure 3 . ( a , b ) Immediately postoperative CXR and the day after surgery CXR , which indicates overall pulmonary edema . ( c ) CXR indicates gradually improving from 5 days after surgery . CXR .: Chest x-ray .
The postoperative course was uneventful and the patient was discharged after undergoing antibiotic treatment for 2 weeks .
Informed consent to report patient information and images was obtained .
Discussion
Protamine covalently binds to anionic heparin forming a stable precipitate and neutralizing the anticoagulant effect of heparin , and is routinely used in cardiac surgery employing CPB [ 1 , 10 ]. The adverse effects of protamine include hypotension , arrhythmias , diaphoresis , flushing , altered consciousness level , catastrophic pulmonary hypertension , and anaphylaxis and anaphylactoid reactions . The diagnosis of this complication is often empirical , based on its close temporal proximity to protamine administration after excluding other possible causes . In patients not receiving Neutral Protamine Hagedorn ( NPH ) insulin and protamine-zinc insulin ( PZI ), the incidence of hypotensive adverse reactions is reported to be 0.06 %, whereas anaphylaxis-like reactions ( severe hypotensive reactions ) in patients receiving NPH insulin are shown to be 0.6 % [ 1 , 10 , 11 ]. Also , the most severe and persistent adverse response to protamine administration for heparin reversal seems