[Anesthetic management of a hemodialysis patient presenting with apparent LV diastolic dysfunction after undergoing...

We present a case of anesthetic management in a hemodialysis patient suffering from constrictive pericarditis who underwent pericardiectomy. The patient was a 54-year-old male, complicated with hypertension, diabetes and coronary artery disease, with congestive heart disease of NYHA III. After anesthetic induction with midazolam and fentanyl, pericardiectomy was performed with CPB stand by for unexpected surgical blood loss. Transesophageal echocardiography (TEE) revealed severely constricted ventricles with normal ejection fraction. CPB was induced due to refractory ventricular fibrillation during pericardiectomy. CPB was discontinued after performing pericardiectomy and CABG, and cardiac index increased from 1.3 to 3.0 l x min(-1) x m(-2) and stroke index increased from 18.6 to 34.1 ml x beats(-1) x m(-2). However, continuous catecholamine infusion including adrenaline and noradrenaline and intraaortic balloon pumping were necessary to maintain systemic blood pressure against systemic hypotension with pulmonary hypertension, regardless of normal cardiac index. TEE after pericardiectomy revealed a dilated right ventricle and unchanged size of the left ventricle compared with those at pre-operative exam. The patient remained in an intensive care for 9 days and was discharged on the 21st post-operative day. NYHA status improved from III to II after the surgery. Post-operative echocardiography revealed dilated left atrium and apparent diastolic dysfunction with normal ejection fraction compared with those in the pre-operative period.