Acute and Resistant İntraoperative Hypertension during Mitral Valve Replacement: A Case Presentation

Main Article Content

Berivan Bedir Sert, M.D. http://orcid.org/0009-0005-9298-0951 Mahmut Yargı, M.D. http://orcid.org/0000-0001-5186-0586 Mehmet Ferit Özdemir, M.D. http://orcid.org/0009-0009-6437-9797 Meral Erdal Erbatur, M.D. http://orcid.org/0000-0001-8970-3359 Tuba İlhan Karaaslan, M.D. http://orcid.org/0009-0007-8358-1339 Osman Uzundere, M.D. http://orcid.org/0000-0002-5968-4561

Abstract

Background: Intraoperative hypertension continues to be a significant cause of morbidity and mortality for patients undergoing surgery. In this case presentation, an instance of sudden, unexpected, and resistant hypertension during surgery will be discussed in a patient who underwent mitral valve replacement.


Case report:  A 75-year-old patient with known coronary artery disease and advanced mitral stenosis underwent mitral valve replacement surgery. During the intraoperative process, after the completion of cannulation procedures and transitioning to partial bypass, a sudden increase in blood pressure was observed in the patient. Blood pressure was only brought under control through the intravenous administration of a triple antihypertensive agent. Upon postoperative evaluation following a smooth completion of the surgery and discharge, findings suggested that the cause of the hypertension in the patient might be renovascular hypertension.


Conclusions: Intraoperative hypertension, when unexpected and sudden, can lead to an increase in mortality and morbidity. During the intraoperative process, efforts should be made to identify the underlying causes promptly, and appropriate interventions should be carried out. In the postoperative period, patients should be thoroughly evaluated for underlying reasons.

Keywords: Antihypertensive drugs, cardiac surgery, mitral stenosis, renovascular hypertension

Article Details

How to Cite
SERT, Berivan Bedir et al. Acute and Resistant İntraoperative Hypertension during Mitral Valve Replacement: A Case Presentation. Medical Research Archives, [S.l.], v. 12, n. 2, feb. 2024. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/5087>. Date accessed: 28 apr. 2024. doi: https://doi.org/10.18103/mra.v12i2.5087.
Section
Research Articles

References

1. Hypertension. [cited 2023 Jun 5]. Available from: https://www.who.int/news-room/fact-sheets/detail/hypertension
2. World Health Organization. Guideline for the pharmacological treatment of hypertension in adults. 2021. Available from: https://www.who.int/publications-detail-redirect/9789240033986
3. Whelton PK, Carey RM, Aronow WS, Casey DE, Collins KJ, Dennison Himmelfarb C, et al. 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Pr. J Am Coll Cardiol. 2018;71(19):e127–248.
4. Hazzi R, Mayock R. Perioperative management of hypertension. J Xiangya Med. 2018;3(25):1–11.
5. Rossi GP, Bisogni V, Rossitto G, Maiolino G, Cesari M, Zhu R, et al. Practice Recommendations for Diagnosis and Treatment of the Most Common Forms of Secondary Hypertension. High Blood Press Cardiovasc Prev. 2020;27(6):547–60. https://doi.org/10.1007/s40292-020-00415-9
6. Barišin S, Šakić K, Goranović T, Barišin A, Sonicki Z. Perioperative blood pressure control in hypertensive and normotensive patients undergoing off-pump coronary artery bypass grafting: Prospective study of current anesthesia practice. Croat Med J. 2007;48(3):341–7.
7. Aronow WS. Management of hypertension in patients undergoing surgery. Ann Transl Med. 2017;5(10):3–5.
8. Krzych LJ. Treatment of hypertension in patients undergoing coronary artery by-pass grafting. Curr Opin Pharmacol. 2012;12(2):127–33. http://dx.doi.org/10.1016/j.coph.2012.01.008
9. Shimada T, Mascha EJ, Yang D, Bravo M, Rivas E, Ince I, et al. Intra-operative hypertension and myocardial injury and/or mortality and acute kidney injury after noncardiac surgery: A retrospective cohort analysis. Eur J Anaesthesiol. 2022;39(4):315–23.
10. Monk TG, Bronsert MR, Henderson WG, et al. Association between Intraoperative Hypotension and Hypertension and 30-day Postoperative Mortality in Noncardiac Surgery. Anesthesiology. 2015;123(2):307-319. doi:10.1097/ALN.0000000000000756
11. McCloskey G, Barash PG. Hypertension and coronary artery bypass surgery. Anesth Hypertens. 1999;17(3):593–607.
12. Travieso-Gonzalez A, Núñez-Gil IJ, Riha H, Donaire JAG, Ramakrishna H. Management of Arterial Hypertension: 2018 ACC/AHA Versus ESC Guidelines and Perioperative Implications. J Cardiothorac Vasc Anesth. 2019;33(12):3496–503. https://doi.org/10.1053/j.jvca.2019.03.068
13. Turner JM, Dmitriev M. Secondary Hypertension Overview and Workup for the Primary Care Physician. Med Clin North Am. 2023;107(4):739-747. doi:10.1016/j.mcna.2023.03.010
14. Dalman J, Coleman DM. Nonatherosclerotic Renovascular Hypertension. Surg Clin North Am. 2023;103(4):733-743. doi:10.1016/j.suc.2023.05.007