BACKGROUND: To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant. CASE PRESENTATION: A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping. CONCLUSION: Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.
BACKGROUND: To prevent cardiac collapse and to protect cerebral function, hypothermic cardiopulmonary bypass is established before resternotomy. However, ventricular fibrillation under hypothermia facilitates left ventricular distension, which causes irreversible myocardial damage when the patient has aortic regurgitation. We report a case of successful management in preventing ventricular fibrillation under hypothermia by using nifekalant. CASE PRESENTATION: A 56-year-old male, who had been performed a David operation, was scheduled for a Bentall operation for a pseudo aortic aneurysm with severe aortic regurgitation. After inducing anesthesia, we administered intravenous nifekalant and a vent tube was inserted into the left ventricle under one-lung ventilation. Extracorporeal circulation was established and resternotomy started after cooling to 27 °C. Although severe bradycardia and QT prolongation were observed, ventricular fibrillation did not occur until aortic cross-clamping. CONCLUSION: Combining maintaining cerebral perfusion and avoiding left ventricle distension during hypothermia was successfully managed with nifekalant in our redo cardiac patient with aortic regurgitation.
Authors: Paul Dorian; Dan Cass; Brian Schwartz; Richard Cooper; Robert Gelaznikas; Aiala Barr Journal: N Engl J Med Date: 2002-03-21 Impact factor: 91.245
Authors: P J Kudenchuk; L A Cobb; M K Copass; R O Cummins; A M Doherty; C E Fahrenbruch; A P Hallstrom; W A Murray; M Olsufka; T Walsh Journal: N Engl J Med Date: 1999-09-16 Impact factor: 91.245
Authors: Ourania Preventza; Andrea Garcia; Sarang A Kashyap; Shahab Akvan; Denton A Cooley; Kiki Simpson; Athina Rammou; Matt D Price; Shuab Omer; Faisal G Bakaeen; Lorraine D Cornwell; Joseph S Coselli Journal: Eur J Cardiothorac Surg Date: 2016-05-17 Impact factor: 4.191