Anest. intenziv. Med. 2014;25(4):277-280

Case report of missed diagnosis of intracranial haemorrhage in a patient after tricuspid valve annuloplastyAnaesthesiology - Case Reports

Matloch Zdeněk^1,*, Říha Hynek¹, Netuka Ivan², Kment Martin³, Kotulák Tomáš¹

¹ Klinika anesteziologie a resuscitace, Institut klinické a experimentální medicíny, Praha

² Klinika kardiovaskulární chirurgie, Institut klinické a experimentální medicíny, Praha

³ Oddělení klinické patologie, Institut klinické a experimentální medicíny, Praha

This case report describes the management of a patient who required reoperation for tricuspid valve regurgitation. The procedure was further complicated by right ventricular failure and an unsatisfactory result of tricuspid valve annuloplasty. On the ICU this patient developed systemic inflammatory response syndrome, followed by multiple-organ failure requiring V-A ECMO. The clinical course was also complicated by acute kidney failure needing continuous renal replacement therapy and by pulmonary haemorrhage requiring several bronchoscopy interventions and blood transfusions. The patient deceased 5 days after surgery. The presumed causes of death were 1) systemic inflammatory syndrome with profound vasoplegia, 2) right ventricular failure and 3) pulmonary haemorrhage. Autopsy revealed assumed shock organ changes but also brain haemorrhage. This unexpected pathology may have contributed to the patient's hemodynamic instability. In a situation where standard neurological methods are inconclusive, novel biochemical markers of brain damage could be helpful.

Keywords: anaesthesia; cerebral protection; mechanical circulatory assistance; valve disease

Received: February 18, 2014; Accepted: May 2, 2014; Published: August 1, 2014  Show citation