[Use of methylene blue in the treatment of vasoplegic syndrome of post-operative heart surgery]. / Utilización de azul de metileno en el tratamiento del síndrome vasopléjico del postoperatorio de cirugía cardíaca.

Vasoplegia is a frequent complication in post-operative heart surgery and determines a significant increase in morbidity-mortality. When vasoplegia persists in spite of optimized fluid therapy with the use of Swan-Ganz catheter, we have a safe, effective and economical alternative, methylene blue. We present the case of a patient who developed vasoplegia refractory to treatment and shock in the scheduled post-operative period of myocardial revascularization. The use of a single dose of methylene blue resolved the hemodynamic instability and allowed for total discontinuation of vasoactive drugs. Thus, we present this new indication of methylene blue, still not approved by the corresponding bodies, for which no national publications have been found and its clinical management and the absence of adverse effects after its use.

Successful thrombolysis on a mechanical tricuspid prosthesis.

Recombinant tissue-type plasminogen activator (rt-PA) is presently used for the treatment of different clinical entities, mostly myocardial infarction. Its use for treatment of thrombotic dysfunction of prosthetic cardiac valves is more recent and has been only rarely reported. A 33-year-old woman with a St Jude Medical prosthesis in the tricuspid position, had suffered from thrombotic dysfunction of her prosthesis for more than 2 months. She was treated with rt-PA, and after infusion of 70 mg, the prosthesis functioned normally. She showed a moderate systemic fibrinolytic state associated with mild bleeding complications.