Protamine-sulfate: Pulmonary hypertension.

A 36-year-old man with a history of hypertension and end-stage renal disease developed pulmonary hypertension during anticoagulant reversal therapy with protamine-sulfate. He presented with chest tightness and shortness of breath and was found to have severe mitral regurgitation. After undergoing mitral valve replacement and receiving heparin, he started anticoagulant reversal therapy with protamine-sulfate. However, this led to elevated pulmonary arterial systolic pressure, causing haemodynamic instability and right ventricular failure. The man was treated with various medications and therapies, including veno-arterial extracorporeal membrane oxygenation, nitric oxide, sildenafil, vasopressors, and cardiotonic therapies. After treatment, his pulmonary arterial systolic pressure improved, and he was successfully weaned off additional therapies. [Extracted from the article]