[Successful recovery and long-term survival following postcardiotomy (mitral valve replacement) cardiogenic shock by means of a left ventricular assist device].
A 48-year-old woman who had had mitral regurgitation associated with hypertension and left ventricular hypertrophy underwent mitral valve replacement with a 29 mm xenograft. Following the uneventful procedure, she could not come off cardiopulmonary bypass for 6 times even with an aid of IABP and with re-replacement of the mitral valve using a 29 mm Duromedics prosthesis because of the fear of xenograft malfunction. A left ventricular assist device (LVAD) was then utilized with a resultant dramatic recovery from profound postcardiotomy cardiogenic shock, and cardiopulmonary bypass was successfully terminated. Postoperatively, her hemodynamics were maintained with a LVAD and IABP. Heparin was used to keep the prosthesis from blood clotting by monitoring the ACT. The heart recovered gradually from intraoperative myocardial damage and the LVAD was successfully removed at the 5th postoperative day. Postoperative cardiac catheterization studies showed decreases in left ventricular wall motion and ejection fraction, although improvements of pulmonary hypertension and left ventricular end-diastolic pressure at rest were observed. At present, 1 year and 9 months after the use of LVAD, she is leading nearly normal life of NYHA grade 1. Because of the excellent present clinical condition of this patient, the benefit of a LVAD in perioperative cardiogenic shock is stressed.
Kitamura
S
S
Mizuguchi
K
K
Kawachi
K
K
Morita
R
R
Nishii
T
T
Koh
Y
Y
D005260:Female; D006350:Heart Valve Prosthesis; D006353:Heart-Assist Devices; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve; D011183:Postoperative Complications; D012770:Shock, Cardiogenic / Q000209:etiology* / Q000628:therapy; D014183:Transplantation, Heterologous