Severe acute respiratory failure after aortic valve replacement in a patient with nonspecific interstitial pneumonia: A case report

Seo, Misook; Lee, Eun Ho; Sim, Ji Yeon

Case Report

Cardiothoracic and Vascular Anesthesia

Anesthesia and Pain Medicine 2014;9(2):123-127.
Published online April 30, 2014.

Severe acute respiratory failure after aortic valve replacement in a patient with nonspecific interstitial pneumonia: A case report

Misook Seo, Eun Ho Lee, Ji Yeon Sim

Department of Anesthesiology and Pain Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea. jysim@amc.seoul.kr

Received: 12 October 2012 • Revised: 31 December 2012

Abstract

A 57-year-old female patient with suspicious interstitial lung disease underwent aortic valvular replacement for aortic stenosis. She complained of severe dyspnea, and her preoperative chest X-ray and computed tomography findings showed multiple ground glass opacity causing interstitial lung disease. After aortic valvular replacement, and as part of the weaning process after cardiopulmonary bypass, she was placed on a ventilator. Nonetheless, the peak airway pressure was higher than 40 mmHg with a less than 50 ml tidal volume, and there was no visible end-tidal CO2 curve. Repeated suction, expansion, and intravenous corticosteroid injection with aminophylline loading were performed to improve the patient's condition. Extracorporeal membrane oxygenation began after cardiopulmonary bypass and was sustained for 5 days. This case demonstrated the fragility of lungs with interstitial disease, and the need to exercise more precaution against acute respiratory failure after cardiopulmonary bypass.

Key Words: Acute respiratory failure, Cardiopulmonary bypass, Interstitial lung disease