ABSTRACT
A 74-year-old man underwent an operation for an extremely large mediastinal tumor. Despite the lack of respiratory difficulty or distention of the jugular veins, preoperative computed tomography showed suppression of the left atrium by the huge tumor. We suspected pulmonary hypertension and monitored continuously with a pulmonary catheter. The Pp/Ps ratio decreased gradually from 0.8 to 0.7 by continuous administration of alprostadil or olprinone. After tumor resection, the Pp/Ps ratio was reduced and maintained at 0.2 even after alprostadil and olprinone administration was discontinued. The tumor was considered to have caused the severe pulmonary hypertension, as anticipated from the preoperative CT.
Subject(s)
Anesthesia, General , Hypertension, Pulmonary/diagnostic imaging , Hypertension, Pulmonary/etiology , Mediastinal Neoplasms/complications , Mediastinal Neoplasms/surgery , Tomography, X-Ray Computed , Aged , Alprostadil/administration & dosage , Humans , Imidazoles/administration & dosage , Male , Perioperative Care , Pyridones/administration & dosageABSTRACT
Takotsubo cardiomyopathy is a cardiac syndrome characterized by transient left ventricular dysfunction. A 79-year-old woman was scheduled for posterior lumbar interbody fusion for spinal compression fracture. After induction of general anesthesia, her blood pressure collapsed with significant ST rise in I, aVL, V3-V5. Emergent transthoracic echocardiography revealed excessive contraction of the base and severe hypokinesis of the apex suggesting Takotsubo cardiomyopathy. Chronic hypovolemia and electrolyte disorder due to habitual glycerin enema were considered to be causes of this sudden cardiac collapse.
