Anesthetic management of renal transplant surgery in a patient with severe mitral regurgitation and moderate pulmonary hypertension as sequelae of infective endocarditis

Abstract

Patients with end-stage renal disease require regular dialysis, mainly through a subclavian or jugular venous catheter, putting them at high risk of infection both due to the invasive catheter and low immunity. We report the successful management of renal transplant in a patient who developed severe mitral regurgitation (MR) due to posterior mitral leaflet perforation and also moderate pulmonary hypertension (PH) and moderate tricuspid regurgitation. The anesthetic target was maintenance of relative tachycardia and prevention of hypothermia, hypoxia and acidosis to prevent further increase in pulmonary resistance as well as correction of any electrolyte imbalance due to underlying chronic kidney disease. This may be the first case of a successful renal transplant in a patient of postinfective endocarditis with sequelae of severe MR and moderate PH.

Keywords

• infective endocarditis
• mitral regurgitation
• perforated mitral valve
• pulmonary hypertension
• renal transplant