Severe pulmonary hypertension in weaning from cardiopulmonary bypass following double Ozaki procedure: a case report

Abstract Background Ozaki surgery, which reconstructs cardiac valves using autologous pericardium, is commonly performed for aortic valve replacement and offers benefits such as avoiding anticoagulation and reducing valve degeneration. However, its application to pulmonary valve replacement remains rare, and anesthetic management for such cases is not well documented. Case presentation A 71-year-old woman with severe aortic and pulmonary valve stenosis underwent double valve replacement using the Ozaki procedure and coronary artery bypass grafting. Post-cardiopulmonary bypass, she developed severe pulmonary hypertension and systemic hypotension. Norepinephrine exacerbated pulmonary hypertension, while arginine vasopressin effectively stabilized systemic pressure without worsening pulmonary pressure. Conclusions This is the first reported case of anesthetic management for double valve replacement using the Ozaki procedure. Adequate use of vasopressin led to ameliorating pulmonary hypertension after cardiopulmonary bypass. Assessing preoperative right ventricular pressure and selecting appropriate vasopressors are crucial in mitigating perioperative pulmonary hypertension.