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Catheter Cardiovasc Interv. 2019 Apr 25. doi: 10.1002/ccd.28214. [Epub ahead of print]

When the pressure drops: A case of vasoplegia during a structural heart intervention.

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Department of Cardiology, Naval Medical Center San Diego, San Diego, California.
Department of Medicine, Naval Medical Center San Diego, San Diego, California.
San Diego Heart and Vascular Associates, San Diego, California.
Department of Cardiology, Scripps Mercy Hospital, San Diego, California.


A 67-year-old male underwent general anesthesia for left atrial appendage occlusion. During the procedure, the patient developed catecholamine refractory hypotension requiring the administration of several vasopressin boluses to maintain adequate perfusion pressure. At the conclusion of the procedure, mild venous bleeding necessitated the administration of protamine. This led to a further decrease in the patient's blood pressure. Tamponade and continued volume loss were quickly ruled out leading to a diagnosis of vasoplegia syndrome (VS). The patient was appropriately treated with a vasopressin infusion with normalization of blood pressure and no significant morbidity or adverse outcome. With the use of general anesthesia during structural heart interventions on the rapid rise, we discuss the two common causes for vasoplegia along with evidence-based treatments and possible prevention strategies.


general anesthesia; structural heart complication; vasoplegia


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