Acute Mesenteric Ischemia after Heart Surgery
V. Goleanu, L. Alecu, O. LazarClinical case, no. 3, 2014
Introduction: Acute mesenteric ischemia (AMI) is a rare but verysevere complication of heart surgery, due especially to the delay in setting the correct diagnosis and choosing the appropriatetreatment. There are 4 types, but the most frequent is nonocclusivemesenteric ischemia (NOMI). The main mechanismis represented by great decrease or maldistribution of the splenicblood flow, with negative impact on the integrity of the intestinalmucosa, bacterial translocation and multiorganic failure.Material and Method: We present a retrospective studyconducted on patients who underwent open heart surgery withcardiopulmonary bypass with non-pulsatile flow. 4 cases ofangiographically confirmed NOMI (non-occlusive mesentericischemia) were identified. When, based on clinical examinationand laboratory findings, acute mesenteric ischemia wassuspicioned, superior mesenteric artery angiography wasperformed via the femoral artery.Results: The main risk factors were represented by: age over 70 years old, left ventricle ejection fraction (LVEF) 35%,aortic clamping time 100 min., chronic kidney failure,counter-pulsation balloon implant, inotropic medication use,like levosimendan, use of blood components 1 unit oferythrocyte mass. Clinical signs were nonspecific. All patientspresented hypoventilation, arterial hypotension, oliguria and,from a biological standpoint, metabolic acidosis andleucocytosis. Superior mesenteric artery angiography was theinvestigation method of choice. Treatment approach wasinitially medical, followed by resection of the intestine.Mortality was 100%.Conclusions: Acute mesenteric ischemia is a rare but verysevere complication in cardiac surgery. It is primordial thatthe main risk factors be known, and in case of diagnosissuspicion, that it be set as early as possible, along withimmediate initiation of an appropriate course of treatment.
