Abstract
Immediately after undergoing emergency mitral valve replacement, a 60-year-old woman suffered acute postoperative right heart failure and could not be weaned from cardiopulmonary bypass, despite treatment with multiple drugs. Circulatory assistance was instituted by means of femoro-femoral bypass with a roller pump and a hollow-fiber oxygenator; inotropic drugs and drugs aimed at reducing pulmonary vascular resistance (nitroprusside, moxaverine, and isoproterenol) were also given. The patient's systolic pulmonary pressure underwent a progressive decrease, but her systolic systemic pressure remained below 60 mmHg until 8.5 hours after aortic clamp release, when we were able to begin an infusion of prostaglandin E1, a drug not readily available in our hospital. Fifteen minutes after the infusion was started, at 5 ng/kg/min, the patient's systolic systemic pressure reached 85 mmHg and her systolic pulmonary pressure decreased to 55 mmHg. During the next 2 hours, epinephrine treatment was discontinued, and the assisted circulatory flow was reduced to 0.5 L/min/m2, while the PGE1 infusion was increased to 10 ng/kg/min. Assisted circulation was soon discontinued, and the patient's hemodynamic condition remained stable. (Texas Heart Institute Journal 1989;16:110-2)
Keywords: Prostaglandins E
Keywords: assisted circulation
Keywords: heart failure, congestive
Keywords: hypertension, pulmonary
Keywords: cardiopulmonary bypass
Keywords: postoperative complications
Keywords: cardiac output, low
Keywords: drug therapy, combination
Keywords: vasodilator agents
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Selected References
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