[A successful VA bypass treatment in patient with severe pulmonary hypertension]

Report of a case of a patient with pulmonary hypertension associated with pericardial effusion who was treated by VA bypass during life-threatening right ventricular failure. A 63-year-old man was admitted to our hospital complaining of chest pain and dyspnea. Echocardiography revealed the patient had severe pulmonary hypertension and pericardial effusion. Though there were deep Q waves in ECG, his coronary angiography revealed normal coronary arteries. Pulmonary scintigraphy showed no evidence of pulmonary thromboembolism. As he developed hypotension and anuria, emergency pericardial drainage was carried out without any beneficial effect. Because no effective drugs were found to control his systemic hypotension and pulmonary hypertension, he was treated by VA bypass to save his life. Although his systemic pressure rose to normal level following institution of VA bypass, his pulmonary pressure remained high constantly, around 60-70mmHg. The VA bypass was discontinued on the 6th day because of bleeding tendency. 3 months after VA bypass, though he had not been given any drugs to control pulmonary hypertension, his pulmonary arterial pressure dropped down to within normal range. Though the exact mechanism or etiology of pulmonary hypertension remained unclear, this may be a rare case treated by VA bypass successfully for life-threatening right ventricular failure caused by pulmonary hypertension.