International Heart Journal
Online ISSN : 1349-3299
Print ISSN : 1349-2365
ISSN-L : 1349-2365
Case Reports
Successful Treatment of Intractable Fluid Retention Using Tolvaptan After Treatment for Postoperative Mediastinitis in a Patient With a Left Ventricular Assist Device
Mitsutoshi KimuraKan NawataOsamu KinoshitaMasaru HatanoTeruhiko ImamuraKoichiro KinugawaMinoru Ono
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2015 Volume 56 Issue 5 Pages 574-577

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Abstract

The use of implantable continuous-flow left ventricular assist devices (LVADs) as a bridge to transplant is effective for patients with congestive heart failure (HF). However, some patients develop congestive symptoms due to right-sided HF even with LVAD support. Tolvaptan, a vasopressin type 2 receptor antagonist, corrects both congestion and hyponatremia in patients with advanced HF. We report herein a case involving a patient who underwent LVAD implantation and developed hyponatremia and congestive symptoms after negative-pressure wound therapy and omental transposition for postoperative mediastinitis. Hemodynamic evaluation performed after negative-pressure wound therapy revealed elevation of both right arterial pressure and pulmonary capillary wedge pressure, and suggested biventricular dysfunction despite LVAD support. Symptoms improved after starting administration of tolvaptan. Tolvaptan may be useful for correcting hyponatremia and volume overload in patients under LVAD support.

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© 2015 by the International Heart Journal Association
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