Koroner Arter By-Pass Cerrahisi Sonrası Gelişen Şiddetli Hiperbilirubinemi Vakası

Yıl 2016, , 9 - 11, 26.12.2016

Yunus Keser Yılmaz , Meral Ekim Yaşar Turan Mehmet Çelikbilek Çiğdem Ünal Kantekin Hasan Ekim Ferit Çiçekçioğlu

https://doi.org/10.16899/ctd.22493

Öz

Kardiyak cerrahi sonrası postoperatif hiperbilirubineminin sıklığı ve paterni ile komlikasyonları iyi tanımlanmamıştır. Karaciğer disfonksiyonuna bağlı postoperatif hiperbilirubinemi, artan morbidite ve mortalite ile ilişkili olabilir. Biz burada koroner arter bypass cerrahisi sonrası yapılan ekokardiyografide sağ ventrikül kollapsı ve perikardiyal hematom saptanan ve hematom boşaltılması sonucu hemodinamik tablosu düzelen hastayı sunduk. Hastanın total ve direkt bilirubin seviyeleri reoperasyonun birinci gününde, sırasıyla 8,3 mg/dl ve 2,3 mg/dl ye yükseldi. Takipte altıncı günde bilirubin seviyesi maksimum 23.1 mg/dl’ye çıktı. Ultrasonografide hepatik doku ve bilirubin kanalları normal olarak değerlendirildi. Alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) ve gama glutamil transferaz (GGT) gibi hepatik fonksiyon testleri normal olan hastaya spesifik bir tedavi verilmeden hiperbilirubinemi normal değerlere geriledi.

 

Anahtar Kelimeler

Koroner arter bypass, hiperbilirubinemi, karaciğer fonksiyon testleri.

Severe hyperbiluribunemia after coronary artery by-pass surgery: a case report

Öz

The pattern and frequency of hyperbilirubinemia after cardiac surgery and its effect on postoperative complications are not well described. Postoperative hyperbilirubinemia due to liver dysfunction may be associated with increased morbidity and mortality. We present a 60-year-old male patient that we detected pericardial hematoma and collapsed right ventricle after the coronary artery bypass surgery. Patient’s clinical status was improved after the operation for evacuating hematoma. Total bilirubin and direct bilirubin levels of patient were increased up to 8,3 mg/dl  and 2,3 mg/dl respectively in the  first day of  re-operation. In follow up, bilirubin level reached to a maximum level of 23.1 mg/dl on sixth day. In ultrasonography hepatic tissue and bilirubin tract were normal. Hepatic function tests except bilirubin such as alanin aminotransferaz (ALT), aspartat aminotransferaz (AST) and gama glutamil transferaz (GGT) were in normal level. Hyperbilirubinemia resolved spontaneously without any specific treatment.

Anahtar Kelimeler

Coronary artery bypass, hyperbilirubinemia, Liver function tests.

Kaynakça

• Wang MJ, Chao A, Huang CH, et al. Hyperbilirubinemia after cardiac operation. Incidence, risk factors, and clinical significance. J Thorac Cardiovasc Surg 1994;108:429-36.
• Collins JD, Bassendine MF, Ferner R, et al. Incidence and prognostic importance of jaundice after cardiopulmonary bypass surgery. Lancet 1983;1:1119-23.
• Kraev AI, Torosoff MT, Fabian T, et al. Postoperative hyperbilirubinemia is an independent predictor of longterm outcomes after cardiopulmonary bypass. J Am Coll Surg 2008;206:645-53.
• Mastoraki A, Karatzis E, Mastoraki S, et al. Postoperative jaundice after cardiac surgery. Hepatobiliary Pancreat Dis Int 2007;6:383-7.
• Li Q, Guo Y, Ou Q, et al. Gene transfer as a strategy to achieve permanent cardioprotection II: rAAV-mediated gene therapy with heme oxygenase-1 limits infarct size 1 year later without adverse functional consequences. Basic Res Cardiol 2011;106:1367-77.
• Horsfall LJ, Nazareth I, Petersen I. Cardiovascular events as a function of serum bilirubin levels in a large statin-treated cohort. Circulation 2012:CIRCULATIONAHA. 112.114066.
• Gardeback M, Settergren G, Brodin LA. Hepatic blood flow and right ventricular function during cardiac surgery assessed by transesophageal echocardiography. J Cardiothorac Vasc Anesth 1996;10:318-22.
• Chu CM, Chang CH, Liaw YF, et al. Jaundice after open heart surgery: a prospective study. Thorax 1984;39:52-6.