Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

Meng Dai; Zhuling Fan; Xuejie Li

doi:doi:10.11648/j.ijacm.20241201.22

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Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

Meng Dai

, Zhuling Fan

, Xuejie Li^*

Published in International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)

Received: 20 April 2024 Accepted: 8 May 2024 Published: 21 June 2024

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Abstract

Background: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6^th World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. Case presentation: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. Conclusions: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.

Published in	International Journal of Anesthesia and Clinical Medicine (Volume 12, Issue 1)
DOI	10.11648/j.ijacm.20241201.22
Page(s)	62-65
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Mitral Valve Stenosis, Giant Left Atrial Thrombus, Pulmonary Hypertension

References

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[2]	Watson T, Shantsila E, Lip GY. Mechanisms of thrombogenesis in atrial fibrillation: Virchow's triad revisited. Lancet. 2009 Jan 10; 373(9658): 155-66. https://doi.org/10.1016/S0140-6736(09)60040-4
[3]	Simonneau G, Montani D, Celermajer DS, et al. Haemodynamic definitions and updated clinical classification of pulmonary hypertension. Eur Respir J. 2019 Jan 24; 53(1): 1801913. https://doi.org/10.1183/13993003.01913-2018
[4]	Poch D, Mandel J. Pulmonary Hypertension. Ann Intern Med. 2021 Apr; 174(4): ITC49-ITC64. https://doi.org/10.7326/AITC202104200 Epub 2021 Apr 13. PMID: 33844574.
[5]	Tan Z, Roscoe A, Rubino A. Transesophageal Echocardiography in Heart and Lung Transplantation. J Cardiothorac Vasc Anesth. 2019 Jun; 33(6): 1548-1558. https://doi.org/10.1053/j.jvca.2019.01.005
[6]	Watkins DA, Johnson CO, Colquhoun SM, et al. Global, Regional, and National Burden of Rheumatic Heart Disease, 1990-2015. N Engl J Med. 2017 Aug 24; 377(8): 713-722. https://doi.org/10.1056/NEJMoa1603693
[7]	Tamai J, Yoshioka T, Yasuda S, et al. Increase in peak oxygen uptake by restoration of atrial contraction in patients after percutaneous transvenous mitral commissurotomy. J Heart Valve Dis. 1993 Nov; 2(6): 623-8.
[8]	Vora A, Karnad D, Goyal V, et al. Control of rate versus rhythm in rheumatic atrial fibrillation: a randomized study. Indian Heart J. 2004 Mar-Apr; 56(2): 110-6.
[9]	Schwammenthal E, Vered Z, Agranat O, et al. Impact of atrioventricular compliance on pulmonary artery pressure in mitral stenosis: an exercise echocardiographic study. Circulation. 2000 Nov 7; 102(19): 2378-84. https://doi.org/10.1161/01.cir.102.19.2378
[10]	Plaschkes J, Borman JB, Merin G, et al. Giant left atrium in rheumatic heart disease: a report of 18 cases treated by mitral valve replacement. Ann Surg. 1971 Aug; 174(2): 194-201. https://doi.org/10.1097/00000658-197108000-00004
[11]	Harky A, Botezatu B, Kakar S, et al. Mitral valve diseases: Pathophysiology and interventions. Prog Cardiovasc Dis. 2021 Jul-Aug; 67: 98-104. https://doi.org/10.1016/j.pcad.2021.03.008 Epub 2021 Apr 2. PMID: 33812859.
[12]	Vachiéry JL, Tedford RJ, Rosenkranz S, et al. Pulmonary hypertension due to left heart disease. Eur Respir J. 2019 Jan 24; 53(1): 1801897. https://doi.org/10.1183/13993003.01897-2018
[13]	Gennari M, Bartorelli AL, Polvani G, et al. Severe Tricuspid Regurgitation After Percutaneous Removal of a Swan-Ganz Catheter Caught by Suture. Ann Thorac Surg. 2017 Sep; 104(3): e225-e226. https://doi.org/10.1016/j.athoracsur.2017.03.035
[14]	Arnaout S, Diab K, Al-Kutoubi A, et al. Rupture of the chordae of the tricuspid valve after knotting of the pulmonary artery catheter. Chest. 2001 Nov; 120(5): 1742-4. https://doi.org/10.1378/chest.120.5.1742
[15]	Colombier S, Rancati V, Marcucci C, et al. Tricuspid valve Swan-Ganz catheter entrapment before cardiac surgery. Anaesth Rep. 2020 Nov 12; 8(2): e12085. https://doi.org/10.1002/anr3.12085

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APA Style

Dai, M., Fan, Z., Li, X. (2024). Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. International Journal of Anesthesia and Clinical Medicine, 12(1), 62-65. https://doi.org/10.11648/j.ijacm.20241201.22

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ACS Style

Dai, M.; Fan, Z.; Li, X. Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. Int. J. Anesth. Clin. Med. 2024, 12(1), 62-65. doi: 10.11648/j.ijacm.20241201.22

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AMA Style

Dai M, Fan Z, Li X. Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. Int J Anesth Clin Med. 2024;12(1):62-65. doi: 10.11648/j.ijacm.20241201.22

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@article{10.11648/j.ijacm.20241201.22,
  author = {Meng Dai and Zhuling Fan and Xuejie Li},
  title = {Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {1},
  pages = {62-65},
  doi = {10.11648/j.ijacm.20241201.22},
  url = {https://doi.org/10.11648/j.ijacm.20241201.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.22},
  abstract = {Background: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6th World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. Case presentation: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. Conclusions: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.
},
 year = {2024}
}

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TY  - JOUR
T1  - Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

AU  - Meng Dai
AU  - Zhuling Fan
AU  - Xuejie Li
Y1  - 2024/06/21
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241201.22
DO  - 10.11648/j.ijacm.20241201.22
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 62
EP  - 65
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241201.22
AB  - Background: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6th World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. Case presentation: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. Conclusions: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.

VL  - 12
IS  - 1
ER  -

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Author Information

Meng Dai

Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China

Contact Email

http://orcid.org/0009-0005-9137-4685
Zhuling Fan

College of Sciences, Sichuan Agricultural University, Chengdu, China

Contact Email

http://orcid.org/0009-0002-4209-3551
Xuejie Li

Department of Anesthesiology, West China Hospital, Sichuan University and The Research Units of West China (2018RU012), Chinese Academy of Medical Sciences, Chengdu, China

Contact Email

http://orcid.org/0000-0001-9706-3435

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Plain Text BibTeX RIS

APA Style

Dai, M., Fan, Z., Li, X. (2024). Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. International Journal of Anesthesia and Clinical Medicine, 12(1), 62-65. https://doi.org/10.11648/j.ijacm.20241201.22

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ACS Style

Dai, M.; Fan, Z.; Li, X. Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. Int. J. Anesth. Clin. Med. 2024, 12(1), 62-65. doi: 10.11648/j.ijacm.20241201.22

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AMA Style

Dai M, Fan Z, Li X. Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus. Int J Anesth Clin Med. 2024;12(1):62-65. doi: 10.11648/j.ijacm.20241201.22

Copy | Download

@article{10.11648/j.ijacm.20241201.22,
  author = {Meng Dai and Zhuling Fan and Xuejie Li},
  title = {Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus
},
  journal = {International Journal of Anesthesia and Clinical Medicine},
  volume = {12},
  number = {1},
  pages = {62-65},
  doi = {10.11648/j.ijacm.20241201.22},
  url = {https://doi.org/10.11648/j.ijacm.20241201.22},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijacm.20241201.22},
  abstract = {Background: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6th World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. Case presentation: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. Conclusions: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.
},
 year = {2024}
}

Copy | Download

TY  - JOUR
T1  - Catastrophic Cardiac Arrest Caused by Acute Pulmonary Hypertension After Removal of Giant Left Atrial Thrombus

AU  - Meng Dai
AU  - Zhuling Fan
AU  - Xuejie Li
Y1  - 2024/06/21
PY  - 2024
N1  - https://doi.org/10.11648/j.ijacm.20241201.22
DO  - 10.11648/j.ijacm.20241201.22
T2  - International Journal of Anesthesia and Clinical Medicine
JF  - International Journal of Anesthesia and Clinical Medicine
JO  - International Journal of Anesthesia and Clinical Medicine
SP  - 62
EP  - 65
PB  - Science Publishing Group
SN  - 2997-2698
UR  - https://doi.org/10.11648/j.ijacm.20241201.22
AB  - Background: Pulmonary hypertension (PH) is defined as a resting mean pulmonary arterial pressure (mPAP) >20 mmHg on right heart catheterization, as described in the proceedings of the 6th World Symposium on Pulmonary Hypertension. Left-sided heart failure (left heart disease) is the most common cause of pulmonary hypertension (PH). Transesophageal echocardiography (TEE) plays an important role in the monitoring of PH. But the disadvantage of TEE is the lack of continuity of monitoring. For patients with severe mitral stenosis and severe PH, should the Swan-Ganz catheter be placed routinely? The monitoring of pulmonary artery pressure and pulmonary venous pressure by Swan-Ganz catheter can guide the management of perioperative circulation and respiration, especially for early detection of PH. Case presentation: This case report introduce a severe mitral valve stenosis with giant left atrium thrombosis performing cardiac surgery. After the removal of giant left atrial mass and mitral valve replacement under cardiopulmonary bypass (CPB), the patient gradually experienced difficulty in ventilation and persistent refractory hypotension, followed by ventricular fibrillation during the process of chest closure. Conclusions: TEE helps diagnose acute pulmonary hypertension. Although TEE plays an important role in the diagnosis and the decision to use mechanical devices, a Swan-Ganz catheter would be an effective hemodynamic monitoring device and can be used in conjunction with TEE in cardiac surgery.

VL  - 12
IS  - 1
ER  -

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