New Treatment With Human Atrial Natriuretic Peptide for Postoperative Myonephropathic Metabolic Syndrome

Adjunctive Ischemic Lower-Limb Perfusion during Aortic Repair with Cardiopulmonary Bypass Prevents Fatal Reperfusion Injury

Acute aortic dissection can be complicated by malperfusion syndromes, including ischemia of the lower limbs. In some cases, delayed correction of leg ischemia leads to reperfusion injury, potentially resulting in renal failure. We describe the case of a 64-year-old woman who presented with acute aortic dissection manifesting itself as lower-limb ischemia. During and after aortic surgery with cardiopulmonary bypass, the patient developed myonephropathic metabolic syndrome. Hyperkalemia was corrected and acute kidney injury was prevented by infusing large volumes of intravenous fluids and administering human atrial natriuretic peptide. Peripheral bypass surgery was unnecessary. This case suggests that restoring blood flow to an ischemic leg by means of adjunctive perfusion during aortic repair with cardiopulmonary bypass is a viable way to overcome the biochemical instability associated with prolonged ischemia, especially hyperkalemia in the early phase of reperfusion.

Case report: new treatment with Tolvaptan for heart failure after cardiac surgery

The vasopressin V2 receptor antagonist (Tolvaptan) is a new diuretic that selectively promotes the excretion of water. It has been reported to be effective for patients in cardiology, but there have been no reports of its use in the perioperative period after cardiac surgery. We report the usefulness of Tolvaptan for postoperative fluid management in a patient with severe mitral regurgitation due to ischemic cardiomyopathy. Marked improvement was achieved after administration of Tolvaptan for heart failure in the postoperative period.