Department of Clinical Engineering, Kitaharima Medical Center, 926-250, Ichiba-cho, Ono-shi, Hyogo 675-1392, Japan.
Department of Cardiovascular Surgery, Kitaharima Medical Center, 926-250, Ichiba-cho, Ono-shi, Hyogo 675-1392, Japan.
J Extra Corpor Technol. 2024 Sep;56(3):120-124. doi: 10.1051/ject/2024018. Epub 2024 Sep 20.
Severe pulmonary vasoconstriction induced by protamine is a rare complication. We report a case of a 77-year-old male patient with a history of mitral valve plasty (MVP). He underwent redo MVP via right thoracotomy under the totally endoscopic procedure (MICS redo-MVP). Immediately after weaning cardiopulmonary bypass (CPB), protamine was administrated. 10 min later peak systolic pulmonary arterial pressure (sys PAP) rose to 62 mmHg, and 30 min later to 80 mmHg. Due to the negative impact of protamine administration, nitric oxide inhalation (iNO) therapy was started with a concentration of 20 ppm. 10 min after iNO therapy started, sys PAP decreased to 63 mmHg. After entering the intensive care unit (ICU), sys PAP decreased to 35 mmHg. Here, we present an effective iNO therapy case for pulmonary hypertension due to protamine and the patient had a good postoperative recovery. This study was approved by the Institutional Review Board at Kitaharima Medical Center (IRB-0602) with the waiver of informed consent.
鱼精蛋白诱导的严重肺血管收缩是一种罕见的并发症。我们报告了一例 77 岁男性患者，有二尖瓣成形术（MVP）病史。他在完全内窥镜手术（MICS redo-MVP）下行右侧开胸 redo-MVP。体外循环（CPB）脱机后立即给予鱼精蛋白。10 分钟后，收缩期肺动脉压峰值（sys PAP）升至 62mmHg，30 分钟后升至 80mmHg。由于鱼精蛋白给药的负面影响，开始吸入一氧化氮（iNO）治疗，浓度为 20ppm。iNO 治疗开始后 10 分钟，sys PAP 降至 63mmHg。进入重症监护病房（ICU）后，sys PAP 降至 35mmHg。在此，我们报告了一例因鱼精蛋白引起的肺动脉高压的有效 iNO 治疗病例，患者术后恢复良好。本研究经北原医疗中心机构审查委员会（IRB-0602）批准，并豁免了知情同意。
