Harmful effect of epinephrine on postreperfusion syndrome in an elderly liver transplantation recipient with sigmoid ventricular septum

Moon, Young‐Jin; Park, Ji Hyun; Oh, J.K.; Lee, Soo-Ho; Hwang, Gyu‐Sam

doi:10.1097/md.0000000000004394

Cited by 4 publications

(3 citation statements)

References 16 publications

(28 reference statements)

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“…This harmful side effect may outweigh the potential benefit of α-stimulation (which increases the afterload), and it triggered refractory PEA in our case because cardiac output and systemic vascular resistance determine the blood pressure. The treatment for cardiogenic shock due to LVOTO consists of both β-blockers and vasoconstrictors, such as phenylephrine, metaraminol, and norepinephrine [ 5 , 12 ]. PEA can be successfully treated if the conditions are identified and corrected [ 11 ]; hence, we should consider the patient’s underlying conditions that initially induced PEA and should remain cognizant that adrenaline could induce refractory PEA, similar to our case.…”

Section: Discussionmentioning

confidence: 99%

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

et al. 2018

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BackgroundPatients with left ventricular outflow tract obstruction who do not exhibit a dynamic pressure gradient at rest, experience pressure gradient increases of ≥ 30 mmHg only during specific situations; this is called latent left ventricular outflow tract obstruction. It is provoked by increased cardiac contraction and preload and afterload depletion. There are a few reports of patients with it developing cardiac arrest. We present a case of latent left ventricular outflow tract obstruction in which the patient with a sigmoid septum experienced refractory pulseless electrical activity due to conventional advanced cardiac life support.Case presentationA 73-year-old Asian woman on escitalopram and lorazepam was transported to our hospital for chest and back pain with altered consciousness. On arrival, she was in shock and developed pulseless electrical activity. After initiation of conventional cardiopulmonary resuscitation according to adult advanced cardiovascular life support guidelines, she could not regain spontaneous circulation. She was ultimately resuscitated via venoarterial extracorporeal membrane oxygenation initiation. The only abnormal laboratory result at admission was anemia. Her hemodynamic status stabilized after red blood cell transfusion, and venoarterial extracorporeal membrane oxygenation was subsequently terminated. Transthoracic echocardiography showed a sigmoid septum; dobutamine-infused Doppler echocardiography revealed a significant outflow gradient, and continuous monitoring showed Brockenbrough–Braunwald sign, which confirmed a diagnosis of latent left ventricular outflow tract obstruction due to a sigmoid septum. As a result, carvedilol and verapamil were initiated. A follow-up dobutamine-infused Doppler echocardiography showed a reduction of outflow gradient, and she was discharged without any sequelae. Latent left ventricular outflow tract obstruction worsened due to increasing cardiac contraction and the depletion of preload and afterload. Depleted preload occurred due to dehydration and anemia, whereas depleted afterload occurred due to the prescribed drugs, which subsequently caused pulseless electrical activity. Moreover, β-stimulation from the adrenaline probably enhanced the hypercontractile state and caused refractory pulseless electrical activity in our case.ConclusionsPatients with latent left ventricular outflow tract obstruction can progress to cardiogenic shock and pulseless electrical activity due to increased cardiac contraction and depletion of preload and afterload. We should consider the patient’s underlying conditions that induced pulseless electrical activity.

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Section: Discussionmentioning

confidence: 99%

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

et al. 2018

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“…However, various patterns of SAM are known to occur even in cases other than HCM [ 1 ]. This disease has drawn the attention of anesthesiologists due to the fact that SAM causes an obstruction of the LVOT during anesthesia and induces severe hemodynamic instability that may be low-responsive to the conventional treatment [ 2 ].…”

Section: Introductionmentioning

confidence: 99%

Systolic anterior motion of mitral chordae tendineae: prevalence and clinical implications in liver transplantation

2020

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Background: Although systolic anterior motion (SAM) of the mitral valve anterior leaflet is well-known to cause hemodynamic perturbation in many anesthetic situations, the prevalence and clinical implication of SAM of mitral chordae tendineae (chordal SAM) in liver transplantation (LT) has not been evaluated. We aimed to assess the impact of chordal SAM on intraoperative postreperfusion syndrome and short and long-term all-cause mortality.Methods: We retrospectively evaluated 1751 LT recipients from January 2011 to June 2017 who had preoperative echocardiography. Echocardiography-derived parameters and the prevalence of post-reperfusion syndrome between those with chordal SAM and without chordal SAM were compared. The cumulative mortality rate according to the presence of chordal SAM was evaluated by the Kaplan-Meier survival curve. Results: Of the enrolled recipients, 21 (1.2%) had chordal SAM in preoperative echocardiography. Compared to those without chordal SAM, patients with chordal SAM had a smaller end-systolic volume index (median 18 ml/m2 vs. 22 ml/m2, P = 0.015) and end-diastolic volume index (median 52 ml/m2 vs. 63 ml/m2, P = 0.011). However, there was no difference in systolic and diastolic function in echocardiography. The prevalence of intraoperative post-reperfusion syndrome did not show any difference (42.9% vs. 45.3%, P = 1.000). Over the mean 4.8-year follow-up, cumulative 90-day and overall mortality also did not show a difference (Log rank P > 0.05, both).Conclusions: Preoperative screening of echocardiography in LT recipients detects 1.2% of chordal SAM. It is found with small left ventricular volume, but is not related with intraoperative post-reperfusion syndrome and short- and long-term postoperative all-cause mortality in LT.

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“…SAM is predictable,3) especially in patients with very uncommon morphologic features like a basal interventricular septal thickness of > 15 mm, a distance from the mitral coaptation point to the septum of < 25 mm, an angle between the intersection of the mitral and aortic annulus of < 120°, and abnormal mitral leaflet length 4). Although directed maximal medical therapy is preferred,5) a surgical approach is required based on the combined severity of hemodynamic obstruction and clinical consequences.…”

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confidence: 99%

Sigmoid Septum and Aberrant Calcified Papillary Muscle in the Setting of Advanced Hypertrophic Cardiomyopathy: An Unusual Life-threatening Coalescence

Hallo

Kottiech

Castillo

2019

J Cardiovasc Imaging

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Harmful effect of epinephrine on postreperfusion syndrome in an elderly liver transplantation recipient with sigmoid ventricular septum

Abstract: Supplemental Digital Content is available in the text

Cited by 4 publications

References 16 publications

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

Conventional cardiopulmonary resuscitation-induced refractory cardiac arrest due to latent left ventricular outflow tract obstruction due to a sigmoid septum: a case report

Systolic anterior motion of mitral chordae tendineae: prevalence and clinical implications in liver transplantation

Sigmoid Septum and Aberrant Calcified Papillary Muscle in the Setting of Advanced Hypertrophic Cardiomyopathy: An Unusual Life-threatening Coalescence

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