Abdominal aortic aneurysm resection following cholecystectomy and heart transplantation. Case report.
The case of a patient who underwent heart transplantation and cholecystectomy in 1993 and admitted for resection of abdominal aortic aneurysm in May 1997, is reported. About 25 minutes after unclamping the abdominal aorta the patient s blood pressure fell suddenly to 70/40 mmHg. In spite of vigorous fluid administration and infusion of Dopamine and Adrenaline the hemodynamic pattern returned to normal only 15 minutes later. The authors discuss the possible explanations of this behaviour (mesenteric traction syndrome, hypovolemia) and conclude that heart transplant patients are particularly affected by hypotension. Of paramount importance remains therefore the correct evaluation of adequate filling pressures which should be maintained slightly above normal range.
Cristalli
A
A
II-III Servizio di Anestesia e Rianimazione, Ospedale Niguarda Ca Granda, Milan, Italy. Acristalli@yahoo.com
De Gasperi
A
A
Prosperi
M
M
Mazza
E
E
Puttini
M
M
Palmieri
B
B
D017544:Aortic Aneurysm, Abdominal / Q000150:complications / Q000601:surgery*; D017763:Autonomic Denervation; D001810:Blood Volume; D002316:Cardiotonic Agents / Q000627:therapeutic use; D002763:Cholecystectomy; D003131:Combined Modality Therapy; D003250:Constriction; D004298:Dopamine / Q000627:therapeutic use; D004837:Epinephrine / Q000627:therapeutic use; D005440:Fluid Therapy; D006333:Heart Failure / Q000601:surgery; D006339:Heart Rate; D016027:Heart Transplantation / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D007431:Intraoperative Complications / Q000188:drug therapy / Q000209:etiology* / Q000628:therapy; D007676:Kidney Failure, Chronic / Q000150:complications; D008297:Male; D008875:Middle Aged
D002316:Cardiotonic Agents; D004298:Dopamine; D004837:Epinephrine