Successful Treatment of Intractable Fluid Retention Using Tolvaptan After Treatment for Postoperative Mediastinitis in a Patient With a Left Ventricular Assist Device
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- Kimura Mitsutoshi
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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- Nawata Kan
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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- Kinoshita Osamu
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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- Hatano Masaru
- Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo
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- Imamura Teruhiko
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
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- Kinugawa Koichiro
- Department of Therapeutic Strategy for Heart Failure, Graduate School of Medicine, The University of Tokyo
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- Ono Minoru
- Department of Cardiac Surgery, Graduate School of Medicine, The University of Tokyo
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Abstract
The use of implantable continuous-flow left ventricular assist devices (LVADs) as a bridge to transplant is effective for patients with congestive heart failure (HF). However, some patients develop congestive symptoms due to right-sided HF even with LVAD support. Tolvaptan, a vasopressin type 2 receptor antagonist, corrects both congestion and hyponatremia in patients with advanced HF. We report herein a case involving a patient who underwent LVAD implantation and developed hyponatremia and congestive symptoms after negative-pressure wound therapy and omental transposition for postoperative mediastinitis. Hemodynamic evaluation performed after negative-pressure wound therapy revealed elevation of both right arterial pressure and pulmonary capillary wedge pressure, and suggested biventricular dysfunction despite LVAD support. Symptoms improved after starting administration of tolvaptan. Tolvaptan may be useful for correcting hyponatremia and volume overload in patients under LVAD support.
Journal
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- International Heart Journal
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International Heart Journal 56 (5), 574-577, 2015
International Heart Journal Association
