doiSerbia

Successful resuscitation from two cardiac arrests in a female patient with critical aortic stenosis, severe mitral regurgitation and coronary artery disease

Mijušković Dragan (Department of Anesthesiology and Intensive Care, Dedinje Cardiovascular Institute, Belgrade)
Stamenković Dušica M. (Clinic of Anesthesiology and Intensive Care, Military Medical Academy, Belgrade)
Borović Saša (Department of Anesthesiology and Intensive Care, Dedinje Cardiovascular Institute, Belgrade)
Karanikolas Menelaos (Department of Anaesthesiology and Critical Care Medicine, University of Patras School of Medicine, Rion, Greece)

Introduction. The incidence of sudden cardiac death in patients with severe symptomatic aortic stenosis is up to 34% and resuscitation is described as highly unsuccessful. Case report. A 72-year-old female patient with severe aortic stenosis combined with severe mitral regurgitation and three-vessel coronary artery disease was successfully resuscitated following two in-hospital cardiac arrests. The first cardiac arrest occurred immediately after intraarterial injection of low osmolar iodinated agent during coronary angiography. Angiography revealed 90% occlusion of the proximal left main coronary artery and circumflex branch. The second arrest followed induction of anesthesia. Following successful open-chest resuscitation, aortic valve replacement, mitral valvuloplasty and three-vessel aortocoronary bypass were performed. Postoperative pericardial tamponade required surgical revision. The patient recovered completely. Conclusion. Decision to start resuscitation may be justified in selected patients with critical aortic stenosis, even though cardiopulmonary resuscitation in such cases is generally considered futile.

Keywords: heart arrest, resuscitation, aortic valve stenosis, mitral valve insufficiency, coronary artery disease, treatment outcome