[Stuck prosthetic aortic valve resulting in intermittent chest pain and ST depression: a case report].

Dysfunction of any mechanical prosthesis due to thrombus or pannus requires prompt definite diagnosis and therapy. A 55-year-old woman had received a prosthetic valve for aortic regurgitation 3 years before and was admitted for intermittent chest pain. Electrocardiography showed remarkable ST depression in broad leads during chest pain. Coronary angiography and cinefluoroscopy performed for definite diagnosis at the time of the third attack revealed no stenotic lesion in the coronary artery, but an artificial valve stuck in the completely open position. The diagnosis was acute aortic regurgitation caused by the stuck open valve. Urgent reoperation was performed. Abnormal proliferation of pannus trapping the artificial aortic valve was found at the left ventricular-side orifice of the prosthetic valve. Intermittent valvular sticking can cause acute aortic regurgitation and caused the symptomatic intermittent chest pain and ST depression in this patient.

[Anesthetic management of patients undergoing implantation of left ventricular assist system].

We examined the anesthetic management of six patients with end-stage dilated and hypertrophic cardiomyopathy for implantation of left ventricular assist system. Although anesthesia was induced only with fentanyl or with combination of fentanyl and diazepam, hemodynamic changes after the anesthetic induction were variable and preoperative evaluation of left ventricular ejection fraction did not predict the hemodynamic changes. After the weaning from cardiopulmonary bypass, the right ventricular support by catecholamines, such as dopamine and dobutamine, and phosphodiesterase III inhibitors, such as amrinone, and pulmonary vasodilation by inhalation of nitric oxide were useful to maintain volume loading to the left ventricular assist system.