Refractory vasoplegic syndrome in an adult patient with infective endocarditis: a case report and literature review

ABSTRACT

Postoperative vasoplegic syndrome [VS] is characterized by low systemic vascular resistance, normal or elevated cardiac output, and poor response to volume expansion. The incidence ofVS after cardiac surgery requiring cardiopulmonary bypass is about 20%. Sometimes, VS becomes refractory and initial treatments do not work, rendering treatment a great challenge. In this study, we describe a young male patient with endocarditis undergoing tricuspid valve replacement. When being weaned off cardiopulmonary bypass, the patient experienced VS. The patient s blood pressure did not increase after the administration of a high dose of epinephrine and norepinephrine. Therefore, he was commenced on a low dose ofvasopressin and gradually his blood pressure reached the normal range. Although the standard management of VS is a high dose ofvasopressors, this patient was refractory to a combination of epinephrine and norepinephrine; only a vasopressin infusion was able to treat the patient. Eventually, he was weaned from bypass and the operation was terminated satisfactorily