Abstract
Mitochondrial myopathy, encephalopathy, lactic acidosis, and stroke-like episodes (MELAS), a mitochondrial disease characterized by stroke symptoms and multi-organ complications necessitates careful perioperative management. Perioperative management of MELAS requires attention. We report a case in which transesophageal echocardiography (TEE) after induction of general anesthesia confirmed disappearance of a right atrial verruca with avoidance of open heart surgery in a 38-year-old woman with a history of MELAS. The patient developed fever during implantable pacemaker implantation, and blood culture yielded growth of Gram-positive bacilli. Preoperative TEE revealed a giant right atrial verruca. Considering the patient's stable hemodynamic status, open heart surgery was scheduled 9 days later. TEE after induction of general anesthesia showed resolution of the preoperatively visualized giant right atrial verruca.
After consultation with the Departments of Anesthesiology, Cardiovascular Surgery, and Cardiology, we suspected pulmonary thromboembolism secondary to the verruca. Contrast-enhanced chest computed tomography following transfer from the operating room revealed a pulmonary embolus in the right pulmonary artery trunk, and the verruca was removed using transcatheter intervention. After induction of general anesthesia, we confirmed disappearance of the right atrial verruca in this patient with MELAS and successfully avoided open heart surgery.
