Yunus NAZLI, Necmettin ÇOLAK, Mehmet Fatih ALPAY, Ömer ÇAKIR

Successful mitral valve replacement for infective endocarditis in a patient with liver cirrhosis and acute renal failure

Karaciğer sirozu ve akut böbrek yetmezliği olan hastaların, kardiyopulmoner baypas altında gerçekleştirilen açık kalp cerrahisi açısından yüksek risk taşıdığı kabul edilmektedir. Orta derecede karaciğer sirozu eşliğinde bakteriyel endokarditten dolayı ciddi mitral yetmezliği olan 58 yaşında kadın hasta akut pulmoner ödem tedavisi için kliniğimize başvurdu. Ameliyat öncesi karaciğer fonksiyon durumu Child-Pugh sınıf B olarak tespit edildi. Akut enfektif endokardit tedavisi için intravenöz gentamisin ve vankomisin başlandı. Antimikrobiyal tedavi sırasında hastada ilaca bağlı akut böbrek yetmezliği gelişti. Progresif kalp yetmezliğinden dolayı kardiyopulmoner baypas altında acil şekilde mitral kapak replasmanı gerçekleştirildi. Ameliyat sonrası süreci sorunsuz olan hasta taburcu edildi. Dikkatli ameliyat öncesi hazırlık ve iyi bir ameliyat sırası yönetim ile akut böbrek yetmezliği ve orta dereceli karaciğer sirozu olan akut enfektif endokarditli hastalarda açık kalp cerrahisi yüz güldürücü sonuçlarla yapılabilir.

Akut böbrek yetmezliği ve karaciğer sirozu olan enfektif endokarditli hastada başarılı mitral kapak replasmanı

Patients with liver cirrhosis and acute renal failure are considered high risk for open cardiac surgery under cardiopulmonary bypass. A 58-year-old female patient with severe mitral regurgitation due to bacterial endocarditis associated with moderate liver cirrhosis was admitted to our clinic for the treatment of acute pulmonary edema. Preoperative hepatic function state was estimated as Child- Pugh class B. Intravenous gentamicin and vancomycin were initiated for the treatment of acute infective endocarditis. During antimicrobial therapy, the patient developed druginduced acute renal failure. We immediately performed mitral valve replacement under cardiopulmonary bypass due to progressive heart failure. The postoperative course was problem-free and the patient was discharged. With careful preoperative preparation and good perioperative management, open heart surgery can be performed with a positive outcome in acute infective endocarditis patients with moderate liver cirrhosis and acute renal failure.

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