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Binocular blindness following dynamic cardiomyoplasty
R J Robinson1, R Cecere, R C Chiu
1Department of Anaesthesia, McGill University, Montreal, Quebec, Canada.
Insights
A patient experienced sudden blindness and died after severe cardiogenic shock post-dynamic cardiomyoplasty. Ischemic optic neuropathy due to hypoperfusion is suspected, highlighting risks like anemia and hypotension.
Area of Science:
- Cardiology
- Neurology
- Ophthalmology
Background:
- Viral cardiomyopathy presents a significant challenge in cardiac surgery.
- Dynamic cardiomyoplasty is a surgical option for advanced heart failure.
- Postoperative complications, including neurological deficits, can occur.
Abstract:
A 40-year-old man with viral cardiomyopathy underwent uncomplicated dynamic cardiomyoplasty. On the third postoperative day, he was rescued from an 8-hour period of severe cardiogenic shock. Eleven days postoperatively, he was withdrawn and uncooperative, preferring to be left alone. He then complained of total blindness, which persisted to his sudden death on postoperative day 26. Clinical examination revealed no neurological abnormality except for signs consistent with a diagnosis of ischemic optic neuropathy. The optic nerve in the scleral canal is especially vulnerable to hypoperfusion. Blindness has been reported following severe hemorrhage, bilateral neck dissection, and has an incidence of 1 per 1100 cases following cardiopulmonary bypass. Anemia and hypotension may be consistent risk factors predisposing patients to this catastrophic complication.