Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement

An intraoperative dilemma

Michael Essandoh, Juan Portillo, Alix Zuleta-Alarcon, Karina Castellon-Larios, Andrew Otey, Chittoor Sai Sudhakar

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

High transaortic valvular gradients, after combined aortic valve and mitral valve replacement, require prompt intraoperative diagnosis and appropriate management. The presence of high transaortic valvular gradients after cardiopulmonary bypass, in this setting, can be secondary to the following conditions: prosthesis dysfunction, left ventricular outflow tract obstruction, supravalvular obstruction, prosthesis-patient mismatch, hyperkinetic left ventricle from administration of inotropes, left ventricular intracavitary gradients, pressure recovery phenomenon, and increased transvalvular blood flow resulting from hyperdynamic circulation or anemia. Transesophageal echocardiography is an extremely useful tool for timely diagnosis and treatment of this complication. We describe a case of a critically ill patient with endocarditis and acute lung injury, who presented for combined aortic valve and mitral valve replacement. Transesophageal echocardiographic assessment, post-cardiopulmonary bypass, revealed high transaortic valvular gradients due to encroachment of the mitral prosthesis strut on the left ventricular outflow tract, which was compounded by a small, hypertrophied, and hyperkinetic left ventricle. Discontinuation of inotropic support, administration of fluids, phenylephrine, and esmolol led to resolution of the high gradients and prevented further surgery.

Original languageEnglish (US)
Pages (from-to)61-65
Number of pages5
JournalSeminars in Cardiothoracic and Vascular Anesthesia
Volume19
Issue number1
DOIs
StatePublished - Mar 14 2015
Externally publishedYes

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Aortic Valve
Mitral Valve
Prostheses and Implants
Cardiopulmonary Bypass
Heart Ventricles
Ventricular Outflow Obstruction
Acute Lung Injury
Transesophageal Echocardiography
Phenylephrine
Endocarditis
Critical Illness
Anemia
Pressure
Therapeutics

All Science Journal Classification (ASJC) codes

  • Anesthesiology and Pain Medicine
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement : An intraoperative dilemma. / Essandoh, Michael; Portillo, Juan; Zuleta-Alarcon, Alix; Castellon-Larios, Karina; Otey, Andrew; Sai Sudhakar, Chittoor.

In: Seminars in Cardiothoracic and Vascular Anesthesia, Vol. 19, No. 1, 14.03.2015, p. 61-65.

Research output: Contribution to journalArticle

Essandoh, Michael ; Portillo, Juan ; Zuleta-Alarcon, Alix ; Castellon-Larios, Karina ; Otey, Andrew ; Sai Sudhakar, Chittoor. / Elevated transaortic valvular gradients after combined aortic valve and mitral valve replacement : An intraoperative dilemma. In: Seminars in Cardiothoracic and Vascular Anesthesia. 2015 ; Vol. 19, No. 1. pp. 61-65.
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