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Lack of efficacy: case report. A 65-year-old man exhibited lack of efficacy during treatment dobutamine, dopamine, epinephrine and norepinephrine for hypotension. The man presented with worsened dyspnea. He was followed up for valvular heart disease. Several investigation revealed mitral steno-insufficiency, severe aortic insufficiency, aneurysm of ascending aorta, enlarged left ventricle with dysfunction and ejection fraction of 33%. Subsequently, he underwent an elective double valve replacement with combined ascending aorta replacement. His postoperative vital signs were unstable with systolic BP 200mL and the lactic acidosis improved. On the subsequent day, he was extubated. On the next day, gradually the catecholamines were tapered. He was in the ICU for 4 days after surgery. Till day 7 of surgery, the all IV infusions were stopped. Postoperative transthoracic echocardiography revealed decreased left ventricular volume and well functioning both bioprosthetic valves. The highest postoperative creatinine kinase was 30.1 ng/mL. CT angiography revealed normal findings. On day 14 of surgery, he was discharged with no major complications. For 5 years so far, he was doing well. Kim H, et al. Temporary use of unusually high dose of catecholamine improved severe ventricular dysfunction associated with stunned myocardium without significant myocardial injury in a post cardiac surgical patient: A case report. International Journal of Surgery Case Reports 76: 282-284, 2020. Available from: URL: http:// 803518617 doi.org/10.1016/j.ijscr.2020.10.013

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Reactions 5 Dec 2020 No. 1833