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Perioperative management of poly-trauma in a postmitral valve replacement patient with severe left ventricular systolic dysfunction.

Ranjan RV, Sivasubramanian M, Ramachandran TR, Selvamani B - Anesth Essays Res (2015 Jan-Apr)

Bottom Line: The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias.When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively.We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Pondicherry Institute of Medical Sciences, Puducherry, India.

ABSTRACT
The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively. In such situations, the anesthesiologist must have the knowledge hemodynamics, diagnostic evaluations, and treatment modalities, more so regarding various drugs used during anesthesia. We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.

No MeSH data available.


Related in: MedlinePlus

Facial fracture
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Figure 2: Facial fracture

Mentions: A 50-year-old Indian male was admitted with a history of road traffic accident. He was a known case of rheumatic heart disease since the age of 30 years and had undergone a successful MVR surgery 11 years back. He had sustained fracture of the shaft of right femur [Figure 1] and left zygoma, floor of the orbit and left maxilla [Figure 2]. He was scheduled for closed reduction intramedullary nailing of right femur with ORIF of facial fracture. He had no other co-morbidity. His history revealed that prior to the valve replacement; he was in New York Heart Association class IV breathlessness which improved to class III after valve replacement. Prior to the trauma, his effort tolerance was poor; he was only able to walk 300–500 m on level ground without any symptoms of palpitations, fatigue, chest pain or breathlessness. He was receiving oral warfarin 3 mg, digoxin 0.25 mg, enalapril 2.5 mg once daily.


Perioperative management of poly-trauma in a postmitral valve replacement patient with severe left ventricular systolic dysfunction.

Ranjan RV, Sivasubramanian M, Ramachandran TR, Selvamani B - Anesth Essays Res (2015 Jan-Apr)

Facial fracture
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4383126&req=5

Figure 2: Facial fracture
Mentions: A 50-year-old Indian male was admitted with a history of road traffic accident. He was a known case of rheumatic heart disease since the age of 30 years and had undergone a successful MVR surgery 11 years back. He had sustained fracture of the shaft of right femur [Figure 1] and left zygoma, floor of the orbit and left maxilla [Figure 2]. He was scheduled for closed reduction intramedullary nailing of right femur with ORIF of facial fracture. He had no other co-morbidity. His history revealed that prior to the valve replacement; he was in New York Heart Association class IV breathlessness which improved to class III after valve replacement. Prior to the trauma, his effort tolerance was poor; he was only able to walk 300–500 m on level ground without any symptoms of palpitations, fatigue, chest pain or breathlessness. He was receiving oral warfarin 3 mg, digoxin 0.25 mg, enalapril 2.5 mg once daily.

Bottom Line: The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias.When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively.We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.

View Article: PubMed Central - PubMed

Affiliation: Department of Anaesthesiology, Pondicherry Institute of Medical Sciences, Puducherry, India.

ABSTRACT
The anesthetic management of a patient with severe left ventricular (LV) dysfunction undergoing noncardiac surgery poses a challenge to the anesthesiologist as LV dysfunction is commonly complicated by progressive congestive heart failure and malignant arrhythmias. When the cause for LV dysfunction is postvalve replacement, additional complications such as intraoperative thrombosis, bleeding, and infective endocarditis need to be addressed perioperatively. In such situations, the anesthesiologist must have the knowledge hemodynamics, diagnostic evaluations, and treatment modalities, more so regarding various drugs used during anesthesia. We report a case of postmitral valve replaced patient with severe LV dysfunction posted for surgery of fracture of the femur and facial fractures managed successfully during anesthesia.

No MeSH data available.


Related in: MedlinePlus