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[An emergent aortic and mitral valve replacement for active infective endocarditis preoperatively using
H Sakahashi1, A Takazawa, K Eishi
1Department of Cardiovascular Surgery, Heart Institute of Japan, Tokyo Women's Medical College.
Kyobu Geka. the Japanese Journal of Thoracic Surgery
|March 1, 1991
Summary
Extracorporeal ultrafiltration effectively treated acute renal failure in a patient with severe heart failure and endocarditis. This dehydration method stabilized hemodynamics, leading to improved kidney function and successful valve replacement surgery.
Area of Science:
- Cardiology
- Nephrology
- Intensive Care Medicine
Background:
- Active endocarditis can lead to severe valvular regurgitation and heart failure.
- Progressive heart failure can precipitate acute renal failure, complicating patient management.
- Mycotic aneurysms in valvular annuli pose significant surgical risks.
Observation:
- A 29-year-old man presented with active endocarditis, aortic and mitral valve regurgitation, and progressive heart failure leading to anuria.
- Echocardiography revealed a mycotic aneurysm at the aortic valvular annulus and a mitral valve aneurysm.
- Hemodynamics were unstable prior to emergent double valve replacement.
Findings:
- Pre-operative removal of 2,500 ml of fluid using extracorporeal ultrafiltration stabilized hemodynamics.
- The patient experienced good urine output during and after the double valve replacement surgery.
- Extracorporeal ultrafiltration proved effective in managing acute renal failure and improving hemodynamics in this complex case.
Implications:
- Extracorporeal ultrafiltration can be a valuable tool for managing fluid overload and acute renal failure in patients with severe valvular heart disease and heart failure.
- This approach may improve hemodynamic stability, facilitating surgical intervention.
- Early consideration of ultrafiltration may improve outcomes for critically ill cardiac patients with renal compromise.