title: [Delayed onset malignant hyperthermia after a closure of ventricular septal defect].
abstract: An 18 month-old girl was diagnosed as ventricular septal defect (VSD) with mild aortic valve prolapse. She underwent a closure of VSD. Intra-and early postoperative course was uneventful. However, 20 hours after surgery, sudden bradycardia led to cardiac arrest and strong muscle rigidity was seen. Hyperkalemia and metabolic acidosis rapidly progressed and resuscitation was failed. Extracorporeal life support and continuous hemodialysis were initiated, but the patient died with multiple organ failure on 5th postoperative day. Her clinical course supported the diagnosis of delayed onset malignant hyperthermia. Histopathological findings of muscle biopsy were consistent with rhabdomyolysis, and immunopathological stains demonstrated changes as in a Duchenne type muscular dystrophy carrier. Delayed onset malignant hyperthermia is an extremely rare complication of general anesthesia. We should be aware of this lethal condition, which occurs with a certain time lag after surgery, especially when the patient has possible background of myopathy.
authors.affiliation: Department of Cardiovascular Surgery, Institute of Clinical Medicine, University of Tsukuba, Tsukuba, Japan.
authors.forename: C
authors.initials: C
authors.lastname: Tokunaga
authors.forename: Y
authors.initials: Y
authors.lastname: Hiramatsu
authors.forename: M
authors.initials: M
authors.lastname: Noma
authors.forename: M
authors.initials: M
authors.lastname: Takahashi
authors.forename: H
authors.initials: H
authors.lastname: Horigome
authors.forename: N
authors.initials: N
authors.lastname: Iwasaki
authors.forename: S
authors.initials: S
authors.lastname: Takahashi
authors.forename: T
authors.initials: T
authors.lastname: Mizutani
authors.forename: Y
authors.initials: Y
authors.lastname: Sakakibara
mesh_terms: D005260:Female; D006345:Heart Septal Defects, Ventricular / Q000601:surgery*; D006579:Heterozygote; D006801:Humans; D007223:Infant; D008305:Malignant Hyperthermia / Q000209:etiology*; D020388:Muscular Dystrophy, Duchenne / Q000235:genetics; D011183:Postoperative Complications; D013997:Time Factors