Efficacy of tolvaptan for postoperative congestive heart failure after cardiac surgery: a case of mitral valve replacement due to acute mitral regurgitation after coronary intervention

Abstract

A 64-year-old male was admitted to our hospital in the state of a cardiogenic shock with dyspnea. Electrocardiography and trans-thoracic echocardiogram showed an inferior myocardial infarction and coronary angiography revealed a total occlusion in segment 1 of right coronary artery. Percutaneous coronary intervention with bare-metal stents was performed under intra-aortic balloon pumping support, but acute mitral regurgitation was occurred during the procedure. Emergency mitral valve replacement and also optimal medical therapy (inotropic agent, diuretics, Carperitide, etc.) was performed immediately, but congestive heart failure was uncontrolled after operation. Tolvaptan was administered through the gastric tube at 3 days after operation, and the increase of urine volume was accepted without worsening a hemodynamics and a renal function, and congestion heart failure was improved gradually and could wean from the respirator in the 8 days after operation. Tolvaptan was administered for 5 days, the patient showed no worsening of heart failure even after stopping the administration of tolvaptan, and the patient was discharged in the 33 days after operation. Administered of Tolvaptan for the prolonged heart failure after a cardiac surgery was safe and effective.