title: [Refractory pulmonary hypertension following mitral valve repair necessitating percutaneous cardiopulmonary support].
abstract: A 37-year-old woman underwent semi-emergency mitral valve plasty for severe mitral regurgitation and congestive heart failure. Although repair was successfully performed and the left ventricular function was maintained, refractory pulmonary hypertension precluded cessation of cardiopulmonary bypass. Inhalation of nitric oxide was ineffective, and assist circulation was required. All data obtained from the Swan-Ganz catheter and other routine monitors were devastating, and the patient showed no clinical recovery in the early postoperative period. However, transesophageal echocardiography (TEE) performed on the 2nd postoperative day (POD) revealed much better filling of the left heart and the patient was weaned from assist circulation on the 4th POD. Pulmonary vascular disease was denied histologically. Late cardiac catheterization disclosed normal pulmonary artery pressure and resistance. TEE played a key role during very complicated postoperative management. Monitoring of the left atrial pressure might be necessary in cases that require assist circulation due to pulmonary vasoconstriction.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Kawagoe, Japan.
authors.forename: Hiroshige
authors.initials: H
authors.lastname: Sato
authors.forename: Kazuhito
authors.initials: K
authors.lastname: Imanaka
authors.forename: Hideaki
authors.initials: H
authors.lastname: Yamabi
authors.forename: Masahiko
authors.initials: M
authors.lastname: Ando
authors.forename: Takahiro
authors.initials: T
authors.lastname: Matsuoka
mesh_terms: D000328:Adult; D001243:Assisted Circulation; D005260:Female; D006801:Humans; D006976:Hypertension, Pulmonary / Q000209:etiology* / Q000628:therapy*; D008943:Mitral Valve / Q000601:surgery; D008944:Mitral Valve Insufficiency / Q000601:surgery*; D011183:Postoperative Complications