A 30-year-old woman with mitral stenosis and severe pulmonary hypertension underwent mitral valve replacement.
The mitral valve area was 0.7 cm2 and the pulmonary artery systolic pressure was 65 mmHg.
The surgical intervention was performed under moderate hypothermia (30°C), with an aortic clamping of 48 min, implanting a mechanical prosthesis Starr-Macchi N°30.
At the end of surgery, a low cardiac output (CABG) was observed.
Therefore, empirical treatment with vasoactive drugs was initiated with 0.1 mcg/kg/min, noradrenaline 0.28 mcg/kg/min, and amrinine 2 mcg/kg/min, associated with a broad spectrum of sepsis
At the same time, there were other organ failures: 1) acute respiratory failure with high oxygen requirements and PEEP; 2) consumptive coagulopathy, with platelet count of 22,000/mm3, which required massive transfusions 3)
At 36 h postoperatively, cardiac output had worsened and the clinical situation was very critical, which is why we chose to use ADL.
Initially, up to 5 lt/min were used, which were not supported by the left ventricle. Acute pulmonary edema was triggered, which was corrected by acute edema 1,500 rePR min.
This expenditure was maintained for 48 h, allowing control of multiorgan failure and reduction of inotropic drugs.
On the third day of ADL, progressive withdrawal of the ventricular assist system was initiated and, after achieving satisfactory hemodynamics, the implanted circuit was completely removed after 111 h of right ventricular assistance.
No incidents related to the procedure were observed, however, the patient presented some complications due to her multiorgan failure, among which stood out a severe coagulopathy that at the twelfth postoperative day more spontaneous hemoperitoneum and secondary hemoperitoneum.
On postoperative day 14, the patient developed cardiac taping that required percutaneous drainage of 600 mi of blood, which satisfactorily resolved the complication.
On the 20th day after surgery, the patient was removed from the mechanical ventilator.
1.
Renal failure due to acute tubular necrosis maintained the patient on hemodialysis for 6 weeks.
She was discharged 65 days after surgery in good general condition and functional capacity (FC) II.
The patient was referred to her hospital of origin where her control and treatment continued.
Currently, 15 years after mitral valve replacement and the procedure described, the patient is in FC I and on anticoagulant therapy as the only treatment.
A two-dimensional and color Doppler echocardiogram performed in April 2007 showed a left ventricle with ejection fraction (EF) of 62%, and a right ventricle with normal size and contractility.
Systolic pulmonary artery pressure was estimated at 30 mmHg.
