Unveiling the hidden risk: a case of severe jaundice triggered by intra-aortic balloon pump after cardiac surgery.

Abstract

Background: The Intra-Aortic Balloon Pump (IABP) is a widely utilized technique to provide circulatory support for critically ill patients with cardiac dysfunction. While IABP therapy offers clinical benefits, the placement of an IABP catheter can potentially lead to a range of complications in certain high-risk patients. This case report presents a rare instance of progressive jaundice associated with IABP implantation.

Case presentation: The patient was a 56-year-old female who had undergone cardiac valve surgery due to rheumatic combined valve disease. She subsequently developed postoperative low cardiac output syndrome, necessitating the implementation of IABP support. However, the patient exhibited a rapid deterioration in jaundice, coupled with aberrant liver function and suspicion of concurrent pancreatitis. Further thoracoabdominal computed tomography (CT) examinations revealed that when the IABP balloon was fully inflated, the aorta was completely occluded. The diagnosis of hepatic impairment was suspected to likely result from a reduced hepatic blood flow caused by obstruction of the celiac trunk related to the occlusive IABP balloon. Therefore, the IABP was removed, leading to a gradual amelioration of jaundice symptoms as well as bilirubin levels.

Conclusions: This case advocates a reevaluation of the strategy for selecting the size of the IABP balloon, particularly in high-risk patient populations. A marginally smaller balloon size may be warranted to mitigate the risk of vascular-related complications. In cases presenting with progressive jaundice and hepatic impairment following IABP insertion, proactive imaging studies should be promptly conducted to ascertain their correlation with the IABP placement. If there is suspicion of visceral ischemia associated with the IABP balloon, immediate removal of the device should be undertaken to prevent irreversible adverse events.