[Anesthetic Management of Hardy's Operation in a Patient with Acromegalic Heart Disease].

We report the successful anesthetic management of Hardy's operation in a patient with acromegalic heart failure. A 43-year-old man, weighing 98 kg, 182 cm in height, was scheduled for Hardy's operation under general anesthesia. He was admitted 'to our hospital with acute heart failure. At admission, the left ventric- ular ejection fraction (EF) decreased to 20% ; however, the angiography revealed no evidence of coronary artery stenosis. His physical features (enlargement of hand, feet, lips and ears, expansion of the skull at the fontanel) and a high level of growth hormone indicated acromegaly. Thus, we concluded that heart failure was due to acromegaly (acromegaly cardiomyopathy : AHD). The patient was scheduled for Hardy's opera- tion. Anesthesia was induced with midazolam, fentanyl, ketamine, propofol and rocuronium, and maintained with desflurane, remifentanil and intermittent doses of fentanyl. We used FlotracTM/VigileoTM monitor(Edwards Lifesciences) to check cardiac output and stroke vol- ume variation during operation. Intraoperative and postoperative hemodynamic variables remained stable. At follow-up 6 months after operation, he was clinically stable with no recurrence of heart failure, and repeat echocardiography demonstrated resolution of the myo- cardial dysfunction (EF 50%). Although acromegaly is well known as being associated with difficult laryngos- copy and intubation, we should pay attention to the presence of acromegalic heart disease. Improvement of cardiac function is expected after surgical therapy.