Intensive Care Medicine

, Volume 38, Issue 11, pp 1908–1910 | Cite as

Heart transplantation for acute cardiac failure caused by thrombotic thrombocytopenic purpura (TTP)

  • Michel WolffEmail author
  • Richard Dorent
  • Agnès Veyradier
  • Lydia Deschamps
  • Richard Raffoul

Dear Editor,

A 25-year-old woman with known Barlow disease and mitral regurgitation was hospitalized on 22 July 2011 (D1) after 4 days of fever and fatigue. Transesophageal echocardiography revealed mobile vegetation (20 × 0.5 mm) on the posterior mitral leaflet. Computed tomography scan showed two small spleen infarcts, but blood cultures were negative. Neurological examination was normal. Ceftriaxone, gentamicin, and doxycycline were started on D11. Severe acute mitral regurgitation led to pulmonary edema and valve replacement (bioprosthesis) on D21.

Four hours after surgery, she was transferred to our intensive care unit for cardiogenic shock [left ventricular ejection fraction (LVEF) <10 %], followed by asystolic cardiac arrest. Central extracorporeal membrane oxygenation (ECMO) support was started, combined with norepinephrine and continuous venovenous hemodialysis because of multiorgan (renal, hepatic, respiratory) failure. Continuous infusion of unfractionated heparin maintained...


Left Ventricular Ejection Fraction Valve Replacement Plasma Exchange Thrombotic Thrombocytopenic Purpura ADAMTS13 Activity 
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Conflicts of interest



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Copyright information

© Copyright jointly held by Springer and ESICM 2012

Authors and Affiliations

  • Michel Wolff
    • 1
    Email author
  • Richard Dorent
    • 2
  • Agnès Veyradier
    • 3
  • Lydia Deschamps
    • 4
  • Richard Raffoul
    • 2
  1. 1.Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Service de Réanimation Médicale et des Maladies InfectieusesUniversité Paris-DiderotParis Cedex 18France
  2. 2.Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Service de Chirurgie Cardiaque et VasculaireUniversité Paris-DiderotParis Cedex 18France
  3. 3.Assistance Publique–Hôpitaux de Paris, Hôpital Antoine-Béclère, Service D’Hématologie BiologiqueUniversité Paris 11Clamart CedexFrance
  4. 4.Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude-Bernard, Service d’Anatomo-PathologieUniversité Paris-DiderotParis Cedex 18France

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