| Myonephropathic Metabolic Syndrome
after Cardiac or Aortic Surgery |
(Department of Cardiovascular Surgery, Fukui Cardiovascular
Center, Fukui, Japan)
| Hiromichi Fujii |
Hirokazu Ohashi |
Yasushi Tsutsumi |
| Takahiro Kawai |
Toshihide Tsukioka |
Masateru Onaka |
|
Myonephropathic metabolic syndrome
(MNMS) is a fatal complication following open-heart or aortic
surgery. We evaluated 7 cases of MNMS following cardiac or aortic
surgery. The patient's ages ranged from 43 to 81 years old. Of
the 7 patients, four presented with myocardial infarction, which
required coronary artery bypass grafting (CABG), and three presented
with acute aortic dissection. Two patients with Stanford type
A underwent total arch replacement and CABG and 1 patient with
Stanford type B underwent a left axillo-femoral bypass. MNMS
was caused by acute arterial occlusion due to intra-aortic balloon
pumping (IABP) or percutaneous cardio-pulmonary support (PCPS)
in patients who experienced myocardial infarction and acute lower
limb ischemia in patients who experienced aortic dissection.
The ratio of MNMS caused by IABP and PCPS, and acute aortic dissection
was 1.4% and 4.2%, respectively. Four patients died; 3 had undergone
CABG and 1 had undergone an aortic operation 18.5 h after acute
dissection. Both IABP and PCPS were removed early in possible
cases. Limb wash-out was performed in 1 patient, and 5 were treated
with hemodiafiltration. IABP and PCPS should be introduced via
a prosthetic graft if limb ischemia is noticed. MNMS should be
recognized as a disastrous complication of aortic dissection,
and early bypass graft or limb amputation may become the treatment
of choice. We emphasize that hemodiafiltration should begin as
soon as MNMS is diagnosed.
Jpn. J. Cardiovasc. Surg. 32：230 -233 (2003) |
|
