Abstract
To treat type-A acute aortic dissection (Stanford system), the ascending aorta was replaced with a graft using retrograde cerebral perfusion with deep-hypothermic circulatory arrest. This patient later developed rhabdomyolysis. The patient was a 55 year-old man who was 169cm tall, weighed 120kg and body mass index (BMI) 42.0kg·m-2. Red urine was first detected during surgery and persisted after that point. At two days after surgery, the levels of creatine phosphokinase (CPK) and creatinine were 22, 320U·l-1 and 2.2mg·dl-1, respectively. The levels of serum and urinary myoglobin were 43, 000 and 850, 000ng·ml-1, respectively. Due to massive infusion, transfusion, diuretic administration and active body position change, renal insufficiency improved and the patient was discharged from the ICU 18 days after the surgery. However, the patient died of sepsis on postoperative day 40. There is a risk of rhabdomyolysis following extracorporeal circulation or circulatory arrest in morbidly obese patients. We suppose the physical pressure imposed by the patient's body weight may be a worsening factor. Active body position change during prolonged bed rest would be effective.
