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J Thorac Cardiovasc Surg 2001;122:823-824
© 2001 The American Association for Thoracic Surgery

Brief Communications

Reversal of severe vasoplegia with single-dose methylene blue after heart transplantation

From the Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Hannover, Germany.

Received for publication Jan 26, 2001. Accepted for publication Feb 6, 2001. Address for reprints: T. Kofidis, MD, Division of Thoracic and Cardiovascular Surgery, Hannover Medical School, Carl Neuberg Str.1, 30625 Hannover, Germany (E-mail: kofidis@thg.mh-hannover.de).

Low vascular resistance after cardiopulmonary bypass occurs fairly frequently. ^1,3 In the early postoperative phase after heart transplantation, decrease of blood pressure might be aggravated by the effects of antigen release from the donor organ and acute inflammatory response. Decrease of systemic resistance in patients after cardiac transplantation may lead to significant organ hypoperfusion and is usually treated with vasoconstrictors. We report a case of a patient early after heart transplantation in a severe hyperdynamic state, including high cardiac output and low vascular resistance, who was successfully treated with a single dose of methylene blue.

Clinical summary

A 55-year-old man with congestive heart failure (cardiac index, 1.8 L · min^–1 · m^–2) with an automatic implantable cardioverter defibrillator device underwent orthotopic bicaval cardiac transplantation and explantation of the automatic implantable cardioverter defibrillator device. The underlying disease was a dilative cardiomyopathy with a history of myocarditis. Preoperative evaluation revealed impaired left ventricular systolic function (ejection fraction, 20%) and moderate pulmonary hypertension (mean pulmonary artery pressure, 28 mm Hg). The patient was on a program of furosemide, spironolactone, amiodarone, metoprolol, captopril, and digitoxin preoperatively. His clinical status reached New York Heart Association class IV. Blood pressure was 100/60 mm Hg preoperatively.

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