Scholarlink

Background <p>Vasoplegia is a life-threatening intraoperative condition. Methylene blue (MB), a potent inhibitor of nitric oxide (NO) synthase and soluble guanylyl cyclase (sGC), can treat vasoplegia but may antagonize pulmonary arterial hypertension (PAH) drugs that enhance the NO-sGC-cyclic guanosine monophosphate (cGMP) pathway. Although reports on the use of MB for vasoplegia during liver transplantation (LT) have often been published, managing vasoplegia during LT in a patient with cardiopulmonary disease, including portopulmonary hypertension (PoPH) – a subgroup of PAH – with intracardiac shunt, is challenging and has not been reported.</p> Case presentation <p>We report a 57-year-old woman with PoPH, on anti-PAH selexipag with concomitant atrial septal defect (ASD) undergoing deceased donor LT. After portal reperfusion, she developed refractory hypotension, in which mean arterial blood pressure (ABP) was less than 50&#xa0;mmHg and the cardiac index (CI) was maintained at 5.0 L·min<sup>−1</sup>·m<sup>−2</sup>, despite high dose of vasopressin of 4 unit·h<sup>−1</sup>. Diagnosed with vasoplegia, she received 100&#xa0;mg of MB. Mean ABP promptly improved from 45 to above 60&#xa0;mmHg, systolic ABP from around 60 to above 95&#xa0;mmHg, allowing immediate reduction of vasopressin to 0.5 unit·h<sup>−1</sup>. She was transferred to ICU with stable hemodynamics.</p> Conclusion <p>MB can be lifesaving for intraoperative vasoplegia even in patients with PoPH on PAH drug therapy with an ASD, though potential drug interactions with anti-PAH drugs warrant caution.</p>

错误：搜索内容不能为空，请输入英文关键词
错误：关键词超出字数限制，请精简
高级检索

Successful use of methylene blue for severe vasoplegia in a patient with partially-treated portopulmonary hypertension with atrial septal defect undergoing liver transplantation: a case report

  • 期刊论文

  • 出版模式：

    开放获取

  • 发表日期：

    2025年12月7日

查看全文
  • Taiga Ishihara,
  • Gaku Kawamura,
  • Mayuko Nagano,
  • Seiichi Azuma,
  • Kanji Uchida,
  • Taro Kariya

摘要

Background

Vasoplegia is a life-threatening intraoperative condition. Methylene blue (MB), a potent inhibitor of nitric oxide (NO) synthase and soluble guanylyl cyclase (sGC), can treat vasoplegia but may antagonize pulmonary arterial hypertension (PAH) drugs that enhance the NO-sGC-cyclic guanosine monophosphate (cGMP) pathway. Although reports on the use of MB for vasoplegia during liver transplantation (LT) have often been published, managing vasoplegia during LT in a patient with cardiopulmonary disease, including portopulmonary hypertension (PoPH) – a subgroup of PAH – with intracardiac shunt, is challenging and has not been reported.

Case presentation

We report a 57-year-old woman with PoPH, on anti-PAH selexipag with concomitant atrial septal defect (ASD) undergoing deceased donor LT. After portal reperfusion, she developed refractory hypotension, in which mean arterial blood pressure (ABP) was less than 50 mmHg and the cardiac index (CI) was maintained at 5.0 L·min−1·m−2, despite high dose of vasopressin of 4 unit·h−1. Diagnosed with vasoplegia, she received 100 mg of MB. Mean ABP promptly improved from 45 to above 60 mmHg, systolic ABP from around 60 to above 95 mmHg, allowing immediate reduction of vasopressin to 0.5 unit·h−1. She was transferred to ICU with stable hemodynamics.

Conclusion

MB can be lifesaving for intraoperative vasoplegia even in patients with PoPH on PAH drug therapy with an ASD, though potential drug interactions with anti-PAH drugs warrant caution.