Paraplegia After Valvular Surgery After Remote Thoracoabdominal Aortic Aneurysm Repair

Area of Science:

• Cardiovascular Surgery
• Neurology
• Critical Care Medicine

Background:

• Neurological complications, including paraplegia from spinal cord injury, are known risks following aortic repair surgeries.
• However, paraplegia is less commonly associated with cardiac valvular surgery.

Observation:

• A patient with a history of thoracoabdominal and abdominal aortic surgery developed paraplegia after undergoing mitral and tricuspid valve surgery.
• This neurological deficit occurred despite the absence of direct aortic manipulation during the recent valvular procedure.

Findings:

• The paraplegia was attributed to severe temporary postoperative hypotension, with blood pressure dropping as low as 40 mm Hg for over 10 minutes.
• This episode of hypotension likely resulted in critically decreased spinal cord perfusion, leading to ischemic injury.

Implications:

• This case underscores the risk of spinal cord injury and subsequent paraplegia following valvular surgery, particularly in patients with prior aortic interventions.
• Maintaining adequate spinal cord perfusion pressure during the postoperative period is crucial, even after cardiac valve procedures, to prevent devastating neurological outcomes.
• Further research into monitoring and managing spinal perfusion during and after cardiac and aortic surgeries is warranted.