New Treatment With Human Atrial Natriuretic Peptide for Postoperative Myonephropathic Metabolic Syndrome

Sezai, Akira; Hata, Mitsumasa; Niino, Tesuya; Yoshitake, Isamu; Unosawa, Satoshi; Umezawa, Hisaki; Minami, Kazutomo

doi:10.1016/j.athoracsur.2009.02.075

Cited by 3 publications

(5 citation statements)

References 6 publications

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“…1,2 Although no adverse events occur when blood f low is successfully restored early, MNMS resulting from rhabdomyolysis can develop when reperfusion is delayed. [3][4][5][6][7] Because this syndrome results from the influx of harmful metabolites into the systemic circulation after reperfusion, potential death is a concern even in the early phase of reperfusion. Peripheral revascularization without CPB support can be fatal when MNMS occurs; our experience suggests that adjunctive perfusion of the ischemic limb during CPB support, followed by aortic repair, can reduce the risk of death.…”

Section: Discussionmentioning

confidence: 99%

“…1,2 In rare cases, delayed correction of the ischemia can lead to reperfusion injury. [3][4][5][6][7] Myonephropathic metabolic syndrome (MNMS) is characterized by the inf lux of harmful metabolites into the systemic circulation after reperfusion of the ischemic limbs. Restoring blood f low to the legs has been protective against this syndrome; however, management protocols have not been well established.…”

mentioning

confidence: 99%

“…Investigators fail to agree on the timing of initiating leg perfusion and the necessity of cardiopulmonary bypass (CPB) support. [3][4][5][6][7] We describe the case of a patient in whom MNMS developed during and after replacement of the ascending aorta, and our use of CPB to prevent reperfusion injury.…”

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confidence: 99%

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Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Kurisu

Kimura

Mitsuo

et al. 2019

Texas Heart Institute Journal

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Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.

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Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Kurisu

Kimura

Mitsuo

et al. 2019

Texas Heart Institute Journal

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“…In a patient with acute aortic dissection complicated by the myonephropathic metabolic syndrome (MNMS), high-dose (0.1 mg/kg/min) carperitide improved postoperative MNMS without the need for hemodialysis. Although carperitide was originally investigated for heart failure, it has various pharmacologic effects, and MNMS may have been alleviated through a strong diuretic effect and prevention of ischemia/reperfusion injury [51]. Based on our experience with carperitide, a low infusion rate of 0.02 mg/kg/ min is generally sufficient.…”

Section: Thoracic Aortic Surgerymentioning

confidence: 99%

Natriuretic peptides for perioperative management of cardiac surgery

Sezai

Shiono

2016

Journal of Cardiology

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Atrial natriuretic peptide (carperitide) is used to treat heart failure in Japan, while brain natriuretic peptide (nesiritide) is employed in Europe/USA. Patients undergoing cardiac surgery have a complex underlying pathologic state that features increased levels of neurohumoral factors due to activation of the renin-angiotensin-aldosterone system and/or increased sympathetic activity. We considered that perioperative administration of carperitide could be beneficial for cardiac surgery patients, and we have conducted clinical investigations of its use. This article reviews the effects of natriuretic peptides in cardiac surgery patients based on our experience and on previous reports about perioperative management with carperitide or nesiritide.

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“…However, there have been no reports of its use in the perioperative period after cardiac surgery. We previously observed strong cardiac and renal protection, renin-angiotensin-aldosterone system (RAAS) inhibition, prevention of left ventricular remodeling, and antiarrhythmic activity with continuous low-dose infusion of carperitide in patients undergoing cardiac surgery and found that not only the early results, but also the long-term outcome showed improvement [Sezai 2010;Sezai 2009;Sezai 2013]. We subsequently used Tolvaptan to treat heart failure occurring after cardiac surgery, and significant improvement was achieved.…”

Section: Introductionmentioning

confidence: 99%

Case report: New treatment with Tolvaptan for heart failure after cardiac surgery

Sezai¹,

Iida²,

Yoshitake³

et al. 2014

HSF

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The vasopressin V2 receptor antagonist (Tolvaptan) is a new diuretic that selectively promotes the excretion of water. It has been reported to be effective for patients in cardiology, but there have been no reports of its use in the perioperative period after cardiac surgery. We report the usefulness of Tolvaptan for postoperative fluid management in a patient with severe mitral regurgitation due to ischemic cardiomyopathy. Marked improvement was achieved after administration of Tolvaptan for heart failure in the postoperative period.

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New Treatment With Human Atrial Natriuretic Peptide for Postoperative Myonephropathic Metabolic Syndrome

Cited by 3 publications

References 6 publications

Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Natriuretic peptides for perioperative management of cardiac surgery

Case report: New treatment with Tolvaptan for heart failure after cardiac surgery

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