Successful treatment of acute postoperative right heart failure with low-dose prostaglandin e(1) and assisted...

Immediately after undergoing emergency mitral valve replacement, a 60-year-old woman suffered acute postoperative right heart failure and could not be weaned from cardiopulmonary bypass, despite treatment with multiple drugs. Circulatory assistance was instituted by means of femoro-femoral bypass with a roller pump and a hollow-fiber oxygenator; inotropic drugs and drugs aimed at reducing pulmonary vascular resistance (nitroprusside, moxaverine, and isoproterenol) were also given. The patient's systolic pulmonary pressure underwent a progressive decrease, but her systolic systemic pressure remained below 60 mmHg until 8.5 hours after aortic clamp release, when we were able to begin an infusion of prostaglandin E(1), a drug not readily available in our hospital. Fifteen minutes after the infusion was started, at 5 ng/kg/min, the patient's systolic systemic pressure reached 85 mmHg and her systolic pulmonary pressure decreased to 55 mmHg. During the next 2 hours, epinephrine treatment was discontinued, and the assisted circulatory flow was reduced to 0.5 L/min/m(2), while the PGE(1) infusion was increased to 10 ng/kg/min. Assisted circulation was soon discontinued, and the patient's hemodynamic condition remained stable.