VALVULAR AND STRUCTURAL HEART DISEASES
When the pressure drops: A case of vasoplegia during a structural heart intervention
Justin Cox MD, FACC, FSCAI,
Janette Noveras MD,
Travis Harrell MD, FACC, FACP,
Keshav R. Nayak MD, FACC, FSCAI,
Corresponding Author
Justin Cox MD, FACC, FSCAI
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
Correspondence
Justin Cox, Department of Cardiology, Building 3 Suite 303, Naval Medical Center San Diego, San Diego 92134, CA.
Email: [email protected]
Search for more papers by this authorJanette Noveras MD
Department of Medicine, Naval Medical Center San Diego, San Diego, California
Search for more papers by this authorTravis Harrell MD, FACC, FACP
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
Search for more papers by this authorKeshav R. Nayak MD, FACC, FSCAI
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
San Diego Heart and Vascular Associates, San Diego, California
Department of Cardiology, Scripps Mercy Hospital, San Diego, California
Search for more papers by this authorJustin Cox MD, FACC, FSCAI,
Janette Noveras MD,
Travis Harrell MD, FACC, FACP,
Keshav R. Nayak MD, FACC, FSCAI,
Corresponding Author
Justin Cox MD, FACC, FSCAI
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
Correspondence
Justin Cox, Department of Cardiology, Building 3 Suite 303, Naval Medical Center San Diego, San Diego 92134, CA.
Email: [email protected]
Search for more papers by this authorJanette Noveras MD
Department of Medicine, Naval Medical Center San Diego, San Diego, California
Search for more papers by this authorTravis Harrell MD, FACC, FACP
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
Search for more papers by this authorKeshav R. Nayak MD, FACC, FSCAI
Department of Cardiology, Naval Medical Center San Diego, San Diego, California
San Diego Heart and Vascular Associates, San Diego, California
Department of Cardiology, Scripps Mercy Hospital, San Diego, California
Search for more papers by this authorAbstract
A 67-year-old male underwent general anesthesia for left atrial appendage occlusion. During the procedure, the patient developed catecholamine refractory hypotension requiring the administration of several vasopressin boluses to maintain adequate perfusion pressure. At the conclusion of the procedure, mild venous bleeding necessitated the administration of protamine. This led to a further decrease in the patient's blood pressure. Tamponade and continued volume loss were quickly ruled out leading to a diagnosis of vasoplegia syndrome (VS). The patient was appropriately treated with a vasopressin infusion with normalization of blood pressure and no significant morbidity or adverse outcome. With the use of general anesthesia during structural heart interventions on the rapid rise, we discuss the two common causes for vasoplegia along with evidence-based treatments and possible prevention strategies.
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