[A case of rhabdomyolysis after open heart surgery in a child]

Area of Science:

• Cardiology
• Pediatric Surgery
• Nephrology

Background:

• Rhabdomyolysis is typically associated with trauma or conditions like malignant hyperthermia.
• Pediatric cardiac surgery, particularly procedures involving cardiopulmonary bypass (CPB), presents unique risks.
• Aortic regurgitation necessitates complex surgical interventions in children.

Observation:

• An 8-year-old girl developed rhabdomyolysis post-Ross-Konnos operation for aortic regurgitation.
• Ventricular fibrillation occurred after initial CPB weaning, necessitating re-initiation and rapid cooling.
• Prolonged CPB (5 hr 43 min) was followed by myoglobinuria, skin lesions, and markedly elevated CPK levels.

Findings:

• The patient exhibited signs of rhabdomyolysis, including elevated creatine phosphokinase (CPK) levels up to 19,132 IU/L.
• Intraoperative hypoperfusion during CPB was identified as the likely cause of rhabdomyolysis.
• Despite the severity, the patient recovered well with diuretics and aggressive fluid management, avoiding acute renal failure.

Implications:

• Rhabdomyolysis is a rare but significant complication following pediatric cardiopulmonary bypass.
• Prompt recognition and management, including forced diuresis, are vital for preventing renal complications.
• This case highlights the importance of vigilant monitoring for rhabdomyolysis in pediatric cardiac surgery patients.