[Suddenly developing low output syndrome during acute thoracic aortic dissection surgery in a patient with...

A 70-year-old man with progressive systemic sclerosis (PSS) suddenly developed low output syndrome (LOS) after weaning from cardiopulmonary bypass during acute thoracic aortic dissection and died in an early postoperative stage because of multiple organ failure. PSS was kept in a relatively good condition before onset of his surgical disease, but his Raynaud's phenomenon was much worse and inflammation findings were very severe before his operation. We suspected that PSS might have been involved in LOS in this case. PSS has many cardiac complications, for example spasm or organic changes of coronary artery, cardiac fibrosis, arrhythmia, secondary cardiac failure of pulmonary hypertension, pericardial inflammation, and so on, but we speculate that LOS might be caused by peripheral vessel disturbance. LOS occurs easily in chronic hypovolemic states and abnormal response of peripheral vessels due to PSS. We advise more careful anesthetic and circulatory management especially in invasive operation in PSS patients.