Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation
Abstract Background Despite several previous reports, there are no established procedures for intraoperative management in moyamoya disease patients requiring cardiac surgery. Case presentation Herein, we report the case of a 42-year-old man who was scheduled to undergo mitral valve plasty for sever...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2016-07-01
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| Series: | JA Clinical Reports |
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| Online Access: | http://link.springer.com/article/10.1186/s40981-016-0039-4 |
| _version_ | 1818610052190175232 |
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| author | Kazutomo Saito Hiroaki Toyama Yutaka Ejima Masanori Yamauchi |
| author_facet | Kazutomo Saito Hiroaki Toyama Yutaka Ejima Masanori Yamauchi |
| author_sort | Kazutomo Saito |
| collection | DOAJ |
| description | Abstract Background Despite several previous reports, there are no established procedures for intraoperative management in moyamoya disease patients requiring cardiac surgery. Case presentation Herein, we report the case of a 42-year-old man who was scheduled to undergo mitral valve plasty for severe mitral regurgitation. He had been diagnosed with moyamoya disease on the onset of cerebral ischemia at 41 years of age. During the cardiac surgical procedure, the patient was maintained on inhalation anesthesia with 1 to 1.5 % sevoflurane. Sevoflurane causes cerebral vasodilation followed by increased cerebral blood flow, and moreover we expected a sevoflurane preconditioning-induced neuroprotective effect. In addition, we used pulsatile perfusion support to maintain cerebral circulation with intra-aortic balloon pumping during the cardiopulmonary bypass. We aimed to keep the mean arterial pressure constantly above 70 mmHg. We were able to maintain regional cerebral oxygen saturation at 80 % of the baseline value, and could not detect the progression of neurological deficits using follow-up brain single photon emission computed tomography. The patient was discharged 16 days after admission. Conclusions The details of the clinical course of his case will add to our knowledge regarding intraoperative management options in moyamoya disease patients requiring cardiac surgery. We suggest that pulsatile blood flow supported by intra-aortic balloon pumping and sevoflurane anesthesia for increasing cerebral blood flow and for possible neuroprotection may be efficacious for anesthetic management of moyamoya disease patients. |
| first_indexed | 2024-12-16T15:08:18Z |
| format | Article |
| id | doaj.art-ecd318dda2c5464c882fd16ff9e8018e |
| institution | Directory Open Access Journal |
| issn | 2363-9024 |
| language | English |
| last_indexed | 2024-12-16T15:08:18Z |
| publishDate | 2016-07-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | JA Clinical Reports |
| spelling | doaj.art-ecd318dda2c5464c882fd16ff9e8018e2022-12-21T22:27:02ZengSpringerOpenJA Clinical Reports2363-90242016-07-01211510.1186/s40981-016-0039-4Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitationKazutomo Saito0Hiroaki Toyama1Yutaka Ejima2Masanori Yamauchi3Department of Anesthesiology, Tohoku University HospitalDepartment of Anesthesiology, Tohoku University HospitalDivision of Surgical Center and Supply, Sterillization, Tohoku University HospitalAnesthesiology and Perioperative Medicine, Tohoku University School of MedicineAbstract Background Despite several previous reports, there are no established procedures for intraoperative management in moyamoya disease patients requiring cardiac surgery. Case presentation Herein, we report the case of a 42-year-old man who was scheduled to undergo mitral valve plasty for severe mitral regurgitation. He had been diagnosed with moyamoya disease on the onset of cerebral ischemia at 41 years of age. During the cardiac surgical procedure, the patient was maintained on inhalation anesthesia with 1 to 1.5 % sevoflurane. Sevoflurane causes cerebral vasodilation followed by increased cerebral blood flow, and moreover we expected a sevoflurane preconditioning-induced neuroprotective effect. In addition, we used pulsatile perfusion support to maintain cerebral circulation with intra-aortic balloon pumping during the cardiopulmonary bypass. We aimed to keep the mean arterial pressure constantly above 70 mmHg. We were able to maintain regional cerebral oxygen saturation at 80 % of the baseline value, and could not detect the progression of neurological deficits using follow-up brain single photon emission computed tomography. The patient was discharged 16 days after admission. Conclusions The details of the clinical course of his case will add to our knowledge regarding intraoperative management options in moyamoya disease patients requiring cardiac surgery. We suggest that pulsatile blood flow supported by intra-aortic balloon pumping and sevoflurane anesthesia for increasing cerebral blood flow and for possible neuroprotection may be efficacious for anesthetic management of moyamoya disease patients.http://link.springer.com/article/10.1186/s40981-016-0039-4Moyamoya diseaseCardiopulmonary bypassIntra-aortic balloon pumpingSevofluranePreconditioning |
| spellingShingle | Kazutomo Saito Hiroaki Toyama Yutaka Ejima Masanori Yamauchi Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation JA Clinical Reports Moyamoya disease Cardiopulmonary bypass Intra-aortic balloon pumping Sevoflurane Preconditioning |
| title | Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| title_full | Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| title_fullStr | Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| title_full_unstemmed | Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| title_short | Anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| title_sort | anesthetic management in an adult moyamoya disease patient undergoing mitral valve plasty for severe mitral regurgitation |
| topic | Moyamoya disease Cardiopulmonary bypass Intra-aortic balloon pumping Sevoflurane Preconditioning |
| url | http://link.springer.com/article/10.1186/s40981-016-0039-4 |
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