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Indexed/Abstracted in: EMBASE, Scopus, Emerging Sources Citation Index
Online ISSN 1827-1782
Oliver E., Torrado H., Saura E., Carrió L., Rodriguez D., Farrero E., Ruiz A., Castells E., Ventura J. L.
Intensive Care Unit and Cardiac Surgery Department Bellvitge University Hospital Hospitalet Llobregat, Barcelona, Spain
The case we report is that of a 81 year-old- male with severe degenerative mitral regurgitation who underwent major cardiac surgery. Surgical procedure involved a quadrangular resection of P2-P3 and a Jostra-Puig annuloplasty reduced to 29 mm. He was admitted to the intensive care unit (ICU) for cardiogenic shock immediately after the surgery and an uneventful anaesthetic treatment. Perioperative myocardial infarction was ruled out on the basis of electrocardiogram (ECG), troponin levels and echocardiographic findings; the shock was attributed to deficient cardiac preservation. Transthoracic echocardiography showed a left ventricular ejection fraction (LVEF) of 12%. No evidence of significant valve dysfunction or segmentary deficits in the myocardial contraction were found. Intraaortic balloon pumping was rejected due to abnormal pulse in lower limbs. With mechanical ventilation, sedation, dobutamine, norepinephrine and diuretics, the situation improved but the decrease of inotropic drugs was not tolerated. Therefore, the calcium sensitizer drug levosimendan, which exerts positive inotropic activity without increasing myocardial oxygen demand was administered without a loading dose. The infusion was maintained for 24 hours rather than a “conservative” 12 hours.At the end of the perfusion LVEF increased significantly, reaching 40% according to echocardiography. He was discharged from the ICU in good clinical condition and the last echocardiogram before hospital discharge revealed a LVEF of 54%. Beneficial effects of levosimendan are demonstrated in myocardial stunning after cardiac surgery, especially when previous contractility is good and there is no myocardial necrosis.