Fifth-time redo mitral valve replacement via right thoracotomy under systemic hyperkalemia cardiopulmonary bypass without aortic cross-clamp.

The surgical management of prosthetic valvular endocarditis (PVE) can be challenging. We report a case of a 46-year-old female patient who had a history of four cardiac operations. We chose a mitral valve replacement via right thoracotomy to enable optimal exposure of the mitral valve (MV). Because of multi-reoperations, we employed systemic hyperkalemia for cardiac arrest to protect the heart during cardiopulmonary bypass (CPB) without aortic cross-clamping. Here, we present a complex operation that performed management of CPB under hyperkalemia and the patient had a good postoperative recovery.

Prognostic value of contralateral suppression on kidney function after surgery in patients with primary aldosteronism.

BACKGROUND AND OBJECTIVE: Adrenalectomy for primary aldosteronism (PA) has been associated with decreased kidney function after surgery. It has been proposed that elimination of excess aldosterone unmasks an underlying failure of the kidney function. Contralateral suppression (CLS) is considered a marker of aldosterone excess and disease severity, and the purpose of this study was to assess the hypothesis that CLS would predict change in kidney function after adrenalectomy in patients with PA. DESIGN AND PATIENTS: Patients with PA referred for adrenal venous sampling (AVS) between May 2011 and August 2021 and who were subsequently offered surgical or medical treatment were eligible for the current study. RESULTS: A total of 138 patients were included and after AVS 85/138 (61.6%) underwent adrenalectomy while 53/138 (38.4%) were treated with MR-antagonists. In surgically treated patients the estimated glomerular filtration rate (eGFR) was reduced by 11.5 (SD: 18.5) compared to a reduction of 5.9 (SD: 11.5) in medically treated patients (p = .04). Among surgically treated patients, 59/85 (69.4%) were classified as having CLS. After adrenalectomy, patients with CLS had a mean reduction in eGFR of 17.5 (SD: 17.6) compared to an increase of 1.8 (SD: 12.8) in patients without CLS (p < .001). The association between CLS and change in kidney function remained unchanged in multivariate analysis. Post-surgery, 16/59 (27.1%) patients with CLS developed hyperkalemia compared to 2/26 (7.7%) in patients without CLS (p = .04). CONCLUSION: This retrospective study found that CLS was a strong and independent predictor of a marked reduction of eGFR and an increased risk of hyperkalemia after adrenalectomy in patients with PA.

Challenging surgical dogma: are routine postoperative day 1 laboratory tests necessary after bariatric operations?

BACKGROUND: Postoperative day (POD) 1 laboratory tests are routinely ordered after bariatric operations. OBJECTIVES: Determine how often these laboratory tests are abnormal and whether they represent value-added care. SETTING: Academic medical center, United States. METHODS: Patients undergoing bariatric operations for obesity and complications from prior bariatric surgery from 1 January 2011 to 12 December 2020 at a single institution were identified. Patients with POD 1 hemoglobin, potassium, creatinine, or glucose serum laboratory tests obtained before 08:00 on POD 1 were reviewed. Laboratory-specific exclusion criteria were applied. Abnormal laboratory test results were a hemoglobin < 8.0 g/dL or a hemoglobin drop of > 3.0 g/dL; a potassium < 3.5 mmol/L (hypokalemia), 5.5-5.9 mmol/L (mild hyperkalemia), or ≥ 6.0 mmol/L (severe hyperkalemia); a creatinine increase of 0.3 g/dL or 1.5X the preoperative value (acute kidney injury); and a glucose > 180 mg/dL (hyperglycemia). Intervention for abnormal hemoglobin, potassium, and glucose was also assessed. RESULTS: Of 2090 patients who underwent bariatric operations, 1969 met inclusion criteria for hemoglobin analysis, 1223 for potassium analysis, 1446 for creatinine analysis, and 563 for glucose analysis. Only 0.2% (n = 4) of patients had a hemoglobin < 8.0 g/dL< and only 3.1% (n = 62) had a > 3.0 g/dL hemoglobin drop. Potassium was abnormal in 2.8% of patients (n = 34 total). An acute kidney injury was diagnosed in 1.8% (n = 26) of patients. Hyperglycemia was identified in 2.1% (n = 12) of patients. Of 5227 laboratory test values, only 1.5% were abnormal. Further, of laboratory tests analyzed for intervention (n = 3781), only 14 (0.4%) were actively acted upon. CONCLUSIONS: Routine POD 1 laboratory tests after bariatric operations seem to be a continuation of a surgical tradition rather than a clinically valuable tool. POD 1 laboratory tests should be ordered based on specific patient co-morbidities and clinical criteria.

[Persistent and serious hyperkalemia after surgery of primary aldosteronism: A case report].

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary aldosteronism", "hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.

A rare cause of idiopathic right outflow tract premature ventricular contraction: Type-4 renal tubular acidosis.

The premature ventricular contractions (PVCs) have usually good prognosis in patients without structural heart disease. In case of left ventricular ejection fraction depression or symptoms, antiarrhythmic drugs or cardiac ablations could be an option for management. We present a case of a patient with high burden of PVC admitted for cardiac ablation. Preoperative assessment revealed hyperkalemia and metabolic acidosis which ended up with type-4 renal tubular acidosis (RTA). Its rare cause and management may draw attention to the possibility of type -4 RTA as the cause of the PVC, and hyperkalemia.

Persistent and serious hyperkalemia after surgery of primary aldosteronism: A case report / 北京大学学报(医学版)

Hyperkalemia was one of the complications after primary aldosteronism surgery. Hyperkalemia after primary aldosteronism surgery was uncommon in clinical practice, especially persistent and serious hyperkalemia was rare. This complication was not attached great importance in clinical work. A case about persistent and serious hyperkalemia after primary aldosteronism adrenal adenoma surgery was reported and the patient was followed-up for fourteen months in this study. This patient had a laparoscopic adrenalectomy due to primary aldosteronism. Hyperkalemia was detected one month after surgery of this patient, the highest level of plasma potassium was 7.0 mmol/L. The patient felt skin itchy, nausea, palpitation. Plasma aldosterone concentration fell to 2.12 ng/dL post-operation from 35.69 ng/dL pre-operation, zona glomerulosa insufficiency was confirmed by hormonal tests in this patient after surgery. And levels of 24 hours urinary potassium excretion declined. Decrease of aldosterone levels after surgery might be the cause of hyperkalemia. Hyperkalemia lasted for 14 months after surgery and kalemia-lowering drugs were needed. A systemic search with "primary aldosteronism", "hyperkalemia", "surgical treatment" was performed in PubMed and Wanfang Database for articles published between January 2009 and December 2019. Literature review indicated that the incidence of hyperkalemia after primary aldosteronism surgery was 6% to 29%. Most of them was mild to moderator hyperkalemia (plasma potassium 5.5 to 6.0 mmol/L) and transient. 19% to 33% in hyperkalemia patients was persistent hyperkalemia. Previous studies in the levels of plasma potassium reached the level as high as 7 mmol/L in our case were rare. Whether hypoaldosteronemia was the cause of hyperkalemia was not consistent in the published studies. Risk factors of hyperkalemia after primary aldosteronism surgery included kidney dysfunction, old age, long duration of hypertention. This paper aimed to improve doctors' aweareness of hyperkalemia complication after primary aldosteronism surgery. Plasma potassium should be monitored closely after primary aldosteronism surgery, especially in the patients with risk factors. Some patients could have persistent and serious hyperkalemia, and need medicine treatment.

Presentación fatal de un mixoma cardiaco / Fatal presentation of a cardiac myxoma

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An unusual case of acute hyperkalemia during pregnancy.

We report a rare case of acute hyperkalemia in a patient with chronic kidney disease and intrauterine fetal demise. We propose that the hyperkalemia was due to a potassium load introduced into the maternal circulation as a result of intrauterine fetal demise and uterine rupture.