A case of delayed emergence after aortic root and ascending aorta replacement, which was probably caused by portosystemic shunt

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  • Go Seimei
    Department of Cardiovascular Surgery, Cardiovascular Center, Akane-Foundation Tsuchiya General Hospital
  • Takahashi Shinya
    Department of Cardiovascular Surgery, Hiroshima University hospital
  • Morita Shyohei
    Department of Cardiovascular Surgery, Hiroshima University hospital
  • Maeda Kazuki
    Department of Cardiovascular Surgery, Hiroshima University hospital
  • Katayama Keijiro
    Department of Cardiovascular Surgery, Hiroshima University hospital
  • Kurosaki Takuya
    Department of Cardiovascular Surgery, Hiroshima University hospital
  • Kondo Takashi
    Department of Anesthesia, Hiroshima University hospital
  • Murashita Junji
    Department of Surgery, Aoyama-Foundation Saijyochuo Hospital
  • Sueda Taijiro
    Department of Cardiovascular Surgery, Hiroshima University hospital

Bibliographic Information

Other Title
  • 大動脈基部・上行置換術後の覚醒遅延に門脈体循環シャントの関与が疑われた一例
  • 症例報告 大動脈基部・上行置換術後の覚醒遅延に門脈体循環シャントの関与が疑われた一例
  • ショウレイ ホウコク ダイドウミャク キブ ・ ジョウギョウ チカン ジュツゴ ノ カクセイ チエン ニ モンミャクタイ ジュンカン シャント ノ カンヨ ガ ウタガワレタ イチレイ

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Abstract

<p>　A 71-year-old male had replacement of the aortic root and ascending aorta for Stanford type A aortic dissection. After the operation, he had liver dysfunction, renal dysfunction, and delayed emergence. Even after liver and kidney function normalized, the delayed emergence continued. Enhanced CT showed a portosystemic shunt, which caused hyperammonemia and was associated with delayed emergence. After he was treated with a branched chain amino acid preparation and lactulose preparation, his consciousness level recovered.</p><p>　Hepatic encephalopathy due to portosystemic shunt was reported in 1950 as Inose type hepatic encephalopathy, which is relatively rare. When hyperammonemia is prolonged postoperatively, it is necessary to confirm the presence or absence of portosystemic shunt.</p>

Journal

  • Cardiovascular Anesthesia

    Cardiovascular Anesthesia 23 (1), 83-87, 2019-08-01

    Japanese Society of Cardiovascular Anesthesiologists

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