Restrictive cardiomyopathy (RCM) is characterized by restrictive filling and reduced diastolic volume of either or both ventricles with normal or near-normal systolic function and wall thickness. In this report, we present a case of tooth extraction for decayed tooth with periapical lesion associated with RCM and severe heart failure.
A 7-year-old girl was admitted to the Department of Medicine Tokyo Women's Medical University Medical Center East because of treatment for severe heart failure following a decision to seek heart transplantation in America. Because dental examination was required during the pre-operative period for heart transplantation, the patient was referred to our department on Aug. 27, 2002.
Clinical and X-ray examination showed decayed left upper first deciduous molar with periapical lesion. After discussion with the Department of Medicine and Anesthesiology, we decided to perform tooth extraction under intravenous sedation. On Sep. 25, intravenous sedation was started with midazolam and pethidine hydrochloride after intravenous injection of ABPC. Thereafter, we observed adverse reaction to sedation and the systolic blood pressure decreased to 65mmHg. Therefore, we changed dosage of DOA from 1γ to 4γ that was continuously administered from the pre-operative period. We carried out tooth extraction under local anesthesia with 2% lidcaine when systolic blood pressure stabilized near 90mmHg. Heparin sodium was also administered continuously during surgery. Instability of blood pressure due to tooth extraction or local anesthesia was not observed.
Postoperatively, there were no symptoms of infection, including increasing of WBC or CRP, and bleeding. The patient went to America to receive heart transplantation on Feb. 24, 2003.
