Anesthesia for tricuspid valve replacement after heart transplantation

A 41 year old male patient had received heart transplantation in U.S. in 1993. When myocardial biopsy was performed in 1998, tendinous cords of the tricuspid valve were injured. Tricuspid regurgitation developed along with right heart insufficiency, and the patient was scheduled for tricuspid replacement. For induction of anesthesia, midazolam and fentanyl were used. After induction, both blood pressure and pulse rate were stable. During extracorporeal circulation, perfusion pressure was controlled at 70-80 mmHg, and the duration of cardio-pulmonary perfusion was about 90 minutes. For withdrawal from extracorporeal circulation, dopamine and dobutamine were used. The course was steady and normal after the withdrawal. In tricuspid valve replacement after heart transplantation, stabilized anesthetic course could be maintained using midazolam and fentanyl.