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Ogi K, Sanui M, Iizuka Y, et al. Successful treatment of nonocclusive mesenteric ischemia after aortic valve replacement with continuous arterial alprostadil infusion: A case report. Int J Surg Case Rep. 2017;35:8-11doi: 10.1016/j.ijscr.2017.03.037.
Ogi, K., Sanui, M., Iizuka, Y., Aomatsu, A., Nakashima, I., Hamamoto, K., Okochi, T., & Lefor, A. K. (2017). Successful treatment of nonocclusive mesenteric ischemia after aortic valve replacement with continuous arterial alprostadil infusion: A case report. International journal of surgery case reports, 358-11. https://doi.org/10.1016/j.ijscr.2017.03.037
Ogi, Kunio, et al. "Successful treatment of nonocclusive mesenteric ischemia after aortic valve replacement with continuous arterial alprostadil infusion: A case report." International journal of surgery case reports vol. 35 (2017): 8-11. doi: https://doi.org/10.1016/j.ijscr.2017.03.037
Ogi K, Sanui M, Iizuka Y, Aomatsu A, Nakashima I, Hamamoto K, Okochi T, Lefor AK. Successful treatment of nonocclusive mesenteric ischemia after aortic valve replacement with continuous arterial alprostadil infusion: A case report. Int J Surg Case Rep. 2017;35:8-11. doi: 10.1016/j.ijscr.2017.03.037. Epub 2017 Mar 30. PMID: 28414997; PMCID: PMC5394210.
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Int J Surg Case Rep. 2017;35:8-11. doi: 10.1016/j.ijscr.2017.03.037. Epub 2017 Mar 30.

Successful treatment of nonocclusive mesenteric ischemia after aortic valve replacement with continuous arterial alprostadil infusion: A case report.

International journal of surgery case reports

Kunio Ogi, Masamitsu Sanui, Yusuke Iizuka, Akinori Aomatsu, Ikue Nakashima, Kohei Hamamoto, Tomohisa Okochi, Alan K Lefor

Affiliations

  1. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  2. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  3. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  4. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  5. Department of Anesthesiology and Critical Care Medicine, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  6. Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  7. Department of Radiology, Jichi Medical University Saitama Medical Center, 1-847 Amanumacho, Omiyaku, Saitama, Saitama, 330-8503, Japan. Electronic address: [email protected].
  8. Department of Surgery, Jichi medical University, 3311-1 Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan. Electronic address: [email protected].

PMID: 28414997 PMCID: PMC5394210 DOI: 10.1016/j.ijscr.2017.03.037

Abstract

INTRODUCTION: Nonocclusive mesenteric ischemia (NOMI) after surgery has an extremely poor prognosis with a mortality rate of 30-100%. We report a patient with NOMI following aortic valve replacement who failed to improve despite continuous intra-arterial infusion of papaverine, but was successfully treated with alprostadil (prostaglandin E1 [PGE1]) infusion.

PRESENTATION OF CASE: The patient is a 77-year-old man who underwent aortic valve replacement. Due to elevated serum lactate levels five hours after intensive care unit admission, superior mesenteric arteriography was performed, establishing the diagnosis of NOMI. Although continuous intra-arterial infusion of papaverine was begun, lactate levels remained elevated. Repeat angiography and laparotomy revealed extensive ischemic changes of the intestine. The vasodilator was changed to PGE1, which improved arterial spasm. The patient ultimately needed an ileocecal resection, but the extent of the resection was limited with concomitant PGE1 administration.

DISCUSSION: In the present patient, although NOMI was unresponsive to appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 salvaged most of the intestine.

CONCLUSIONS: In a patient with recurrent NOMI despite appropriate treatment including intra-arterial infusion of papaverine, continuous intra-arterial infusion of PGE1 may limit the extent of intestinal resection needed. Continuous intra-arterial infusion of PGE1 may be a useful treatment for patients with refractory NOMI.

Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

Keywords: Aorticvalve replacement; Nonocclusive mesenteric ischemia; Papaverine; Postoperative complications; Prostaglandin E1

References

  1. Am J Surg. 1995 Dec;170(6):577-80; discussion 580-1 - PubMed
  2. Ann Thorac Surg. 2001 Nov;72 (5):1583-6 - PubMed
  3. Intern Med. 2008;47(22):2001-6 - PubMed
  4. J Clin Invest. 1975 Dec;56(6):1404-10 - PubMed
  5. Vascular. 2004 Mar;12 (2):114-20 - PubMed
  6. Pol Przegl Chir. 2012 Apr;84(4):214-8 - PubMed
  7. Angiology. 1998 Apr;49(4):267-73 - PubMed
  8. Surgery. 1977 Dec;82(6):848-55 - PubMed
  9. J Vasc Surg. 2002 Mar;35(3):445-52 - PubMed
  10. Int J Surg. 2016 Oct;34:180-186 - PubMed
  11. Ann Surg. 2007 Aug;246(2):229-35 - PubMed
  12. Eur J Cardiothorac Surg. 1999 Feb;15(2):218-20 - PubMed

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