‘Rare’ blood clots led to patient’s death following heart surgery, inquest hears

Blood clots which developed in the lungs of a patient following major heart surgery at a private hospital in Dublin and led to his death were “very rare” and remained undiagnosed until his postmortem, an inquest has heard.
A sitting of Dublin District Coroner’s Court heard on Wednesday that Brendan Lawlor from Carlow died two weeks after having mitral valve repair surgery at the Mater Private Hospital.
The 69-year-old’s cardiothoracic surgeon, Michael Tolan, described the clots as a “rare but recognised” complication of surgery, one which he had seen only “once or twice” in his career.
Although a major cause of concern across all surgeries, cardiac surgery in particular had a “very low incidence”, as high doses of anticoagulants, which are used to prevent blood clots, were administered during surgery, he said.
The inquest heard that Mr Lawlor had been receiving anticoagulants throughout his admission, and had been wearing compression stockings following his surgery.
Once his health deteriorated drastically on July 31st, “there wasn’t any question of blood clots”, Mr Tolan said.
Medical staff believed his health deterioration was related to his lungs, Mr Tolan said, specifically a blocked lung due to thick secretions.
Despite surgery going well on July 15th, Mr Lawlor had been admitted to the intensive care unit six days later due to a deterioration in his health, requiring intubation. This was due to several complications including a chest infection and subcutaneous emphysema, an accumulation of air under the skin which prevented Mr Lawlor from being able to open his eyes, which was later resolved.
By July 30th, Mr Lawlor was well. “We thought his problems were over,” Mr Tolan said.
However, on July 31st, Mr Lawlor suffered respiratory arrest and was pronounced dead soon after.
The blood clots were not diagnosed until Mr Lawlor’s postmortem, the inquest heard.
Mr Tolan explained that a CT scan would have been the sole way of diagnosing the clots, however, Mr Lawlor was “far too sick” to have one.
The inquest heard that Mr Lawlor believed he would be home soon after his repair surgery, and had carried out adjustments to his home to assist with his recovery, namely renovating a bathroom and making arrangements to sleep downstairs.
Coroner Aisling Gannon outlined two options available for the verdict, including one of misadventure, saying the blood clots could be considered an unintended consequence of the surgery, though it would, in no way, infer blame.
However, staff from the Mater Private Dublin suggested that a narrative verdict was more appropriate to reflect the complexities which preceded Mr Lawlor’s death, which Ms Gannon accepted.
Ms Gannon recorded the cause of death as multiple bilateral pulmonary emboli following his surgery, against a background of multiple pre-existing conditions including chronic obstructive pulmonary disease.