Management of a Case of Aortic Valve Replacement with Left Ventricle Clot Removal Developing Acute Kidney Injury in Postoperative Period
Cardiac surgery associated-acute kidney injury (AKI) is a common and a serious complication of cardiac surgery requiring cardiopulmonary bypass and it is the second most common cause of AKI in intensive care unit. Recently, two consensus conferences have suggested new diagnostic criteria to define AKI and risk score to better identify patients who will develop AKI after cardiac surgery. In fact, prompt recognition of high-risk patients could allow a more aggressive management at a reversible stage of an incoming ARF. In this case report, we have discussed a case of 21-year-old patient with bicuspid aortic valve with severe aortic stenosis with ejection fraction 15% and left ventricle (LV) clot undergoing surgery for aortic valve replacement with LV clot removal. In the postoperative period, he developed AKI that was managed successfully by early intervention by slow low efficiency dialysis and diafiltration and hemodialysis and patient discharged successfully from hospital.
01 November 2020 (online)
© 2020. Official Publication of The Simulation Society TSS, accredited by International Society of Cardiovascular Ultrasound ISCU. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. https://creativecommons.org/licenses/by-nc-nd/4.0/.
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- 1 Meersch M, Schmidt C, Zarbock A. Perioperative acute kidney injury: an under-recognized problem. Anesth Analg 2017; 125 (04) 1223-1232
- 2 Thakar CV, Arrigain S, Worley S, Yared JP, Paganini EP. A clinical score to predict acute renal failure after cardiac surgery. J Am Soc Nephrol 2005; 16 (01) 162-168
- 3 Chertow GM, Lazarus JM, Christiansen CL. et al. Preoperative renal risk stratification. Circulation 1997; 95 (04) 878-884
- 4 Dries DL, Exner DV, Domanski MJ, Greenberg B, Stevenson LW. The prognostic implications of renal insufficiency in asymptomatic and symptomatic patients with left ventricular systolic dysfunction. J Am Coll Cardiol 2000; 35 (03) 681-689
- 5 Gumbert SD, Kork F, Jackson ML. et al. Perioperative acute kidney injury. Anesthesiology 2020; 132 (01) 180-204 [PubMed PMID: 31687986]
- 6 Elahi M, Asopa S, Pflueger A, Hakim N, Matata B. Acute kidney injury following cardiac surgery: impact of early versus late haemofiltration on morbidity and mortality. Eur J Cardiothorac Surg 2009; 35 (05) 854-863
- 7 Lameire N, Kellum JA. KDIGO AKI Guideline Work Group. Contrast-induced acute kidney injury and renal support for acute kidney injury: a KDIGO summary (Part 2). Crit Care 2013; 17 (01) 205
- 8 García-Fernández N, Pérez-Valdivieso JR, Bes-Rastrollo M. et al. GEDRCC. Timing of renal replacement therapy after cardiac surgery: a retrospective multicenter Spanish cohort study. Blood Purif 2011; 32 (02) 104-111
- 9 Romagnoli S, Ricci Z, Ronco C. Perioperative acute kidney injury: Prevention, early recognition and supportive measures. Nephron 2018; 140: 105-110