Elevated Transaortic Valvular Gradients After Combined Aortic Valve and Mitral Valve Replacement: An Intraoperative Dilemma

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.

Source: Seminars in Cardiothoracic and Vascular Anesthesia - February 9, 2015 Category: Anesthesiology Authors: Essandoh, M., Portillo, J., Zuleta-Alarcon, A., Castellon-Larios, K., Otey, A., Sai-Sudhakar, C. B. Tags: Clinical Challenge Source Type: research