Objective: We present our strategy for successful management of pediatric patients with carcinoid heart disease when weaning from cardiopulmonary bypass (CPB) during tricuspid valve surgery. Case Presentation: The patient was a 14-year-old boy who had been diagnosed with a grade IV neuroendocrine tumor. The patient was premedicated with oral midazolam, hydroxyzine, somatostatin analogue (Octreotide®), and pheniramine maleate. Octreotide® and serotonin 5-hydroxytryptamine receptor antagonist were also added during the rewarming period. Dopamine was continued as an infusion (5 µg kg-1 min-1) for the first day. Bioprosthetic valve placement and transannular right ventricular outflow tract patch augmentation were performed. He was extubated within 20 hours and discharged from the hospital at postoperative 6 day. Discussion: Thanks to the premedication of this case and the addition of somatostatin analogue, pheniramine maleate and methylprednisolone to the pump reservoir and avoiding agents such as atracurium, morphine and meperidine, which may cause histamine release, the surgery was accomplished have been accomplished without development of carcinoid crisis.
Amaç: Bu olgu sunumunda karsinoid kalp tutulumu nedeniyle triküspid kapak replasmanı yapılan çocuk hastada kardiyopulmoner baypastan (KPB) ayrılma sırasında uygulanan strateji anlatılmaktadır. Olgu Sunumu: On dört yaşında olan hastamızın evre IV karaciğer metastazı olan nöroendokrin tümörü vardı. Hastaya premedikasyon amacıyla peroral verilen midazolam ve hidroksizinin yanına somatostatin analogu (Octreotid®) ve feniramin maleat ilave edildi. Octreotid® ve 5-hidroksitriptamin reseptör antagonisti aynı zamanda pompa rezervuarına da yapıldı ve ısınma döneminde doz yinelendi. Triküspid kapak yerine biyolojik kapak yerleştirildi ve pulmoner çıkıma krosanüler yama koyuldu. Postoperatif ilk gün 5 µkg-1 dk-1 dopamin infüzyonu devam etti. Cerrahi sonrası 20. saatte ekstübe edilen hasta, postoperatif 6. gün taburcu oldu. Tartışma: Bu olgunun premedikasyonuna ve pompa rezervuarına somatostatin analogu, feniramin maleat ve metilprednizolon ilave edilmesi ve histamin salımınına neden olabilecek atrakuryum, morfin ve meperidin gibi ajanlardan kaçınılması ile karsinoid kriz gelişmeden cerrahinin tamamlanması sağlanmıştır.
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Patel C, Mathur M, Escarcega RO, et al. Carcinoid heart disease: Current understanding and future directions. Am Heart J. 2014;167:789-95. https://doi.org/10.1016/j.ahj.2014.03.018
Toby N, Weingarten TN, Abel MD, et al. Intraoperative Management of Patients with Carcinoid Heart Disease Having Valvular Surgery: A Review of One Hundred Consecutive Cases. Anesth Analg. 2007;105:1192-9. https://doi.org/10.1213/01.ane.0000284704.57806.0b
Dobson R, Burgess MI, Pritchard DM, et al. The clinical presentation and management of carcinoid heart disease. International Journal of Cardiology. 2014;173:29- 32. https://doi.org/10.1016/j.ijcard.2014.02.037
Suphathamwit A, Dhir A, Dobkowski W, et al. Successful hepatectomy using venovenous bypass in a patient with carcinoid heart disease and severe tricuspid regurgitation. J Cardiothorac Vasc Anesth. 2016;30:446- 51. https://doi.org/10.1053/j.jvca.2015.05.061
Castillo JG, Filsoufi F, Adams DH, et al. Management of patients undergoing multivalvular surgery for carcinoid heart disease: the role of the anaesthetist. Br J Anaesth. 2008;101:618-26. https://doi.org/10.1093/bja/aen237
Bouzas-Mosquera A, Crespo-Leiro MG, Paniagua MJ, et al. Adverse effects of mammalian target of rapamycin inhibitors during the postoperative period after cardiac transplantation. Trans Proc. 2008;40:3027-30. https://doi.org/10.1016/j.transproceed.2008.09.021
Celik N, Cinaz P, Emeksiz HC, et al. Octreotide-Induced Long QT Syndrome in a Child with Congenital Hyperinsulinemia and a Novel Missense Mutation (p. Met115Val) in the ABCC8 Gene. Horm Res Paediatr. 2013;80:299-303. https://doi.org/10.1159/000354666