[Mechanical supports for stunned myocardium after esophagectomy].
Coronary vasospasm can cause a wide spectrum of clinical syndromes ranging from transient myocardial ischemia to irreversible infarction. A 72-year-old male patient had intense vasospasms intraoperatively, which led to stunned myocardium. Though MB fraction of creatine kinase after the spasms was almost within normal limits, postoperative transcutaneous echocardiogram showed diffuse hypokinesis of heart wall motion. He developed low output syndrome, acute respiratory distress syndrome and acute renal failure. He was treated with mechanical supports (intra-aortic balloon pumping, high frequency oscillatory ventilation, and continuous hemodiafiltration), in addition to intravenous administration of cathecolamines, on the first postoperative day. It took 6 days to wean the patient from these mechanical supports and catecholamine infusion. This case suggests stunned myocardium after coronary vasospasm, despite the rapid disappearing ST elevation, and of importance of mechanical supports for the circulatory failure.
Kooguchi
Kunihiko
K
Department of Intensive and Critical Care Medicine, Otsu Municipal Hospital, Otsu 520-0804.
Fukui
Michihiko
M
Tsuruta
Hiroshi
H
Amaya
Fumimasa
F
Shimosato
Goshun
G
Beppu
Satoru
S
Tanaka
Nobuyuki
N
D000368:Aged; D003329:Coronary Vasospasm / Q000150:complications*; D004562:Electrocardiography; D016629:Esophagectomy; D017583:Hemodiafiltration; D006612:High-Frequency Ventilation; D006801:Humans; D007423:Intra-Aortic Balloon Pumping; D008297:Male; D017682:Myocardial Stunning / Q000209:etiology / Q000628:therapy*; D011183:Postoperative Complications