Surgical Aortic Valve Replacement (SAVR) and Unexpected Complication: Critical Illness Related Corticoid Insufficiency (CIRCI). Case Report
Main Article Content
Abstract
Cardiac surgery, particularly surgical aortic valve replacement (SAVR), presents high morbidity risks. This case report describes a 62-year-old male with severe aortic stenosis who developed critical illness-related corticosteroid insufficiency (CIRCI) following SAVR. Postoperatively, the patient exhibited persistent hypotension despite vasopressors, fever, and respiratory complications, along with metabolic disturbances and rapid atrial fibrillation. Adrenal insufficiency was confirmed by low cortisol levels, and hydrocortisone therapy led to clinical improvement. CIRCI remains a diagnostic challenge due to its subtle presentation, yet timely recognition is crucial in high-risk surgical contexts to prevent adverse outcomes.
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
References
I. Chaney, M. A. (2002). Corticosteroids and cardiopulmonary bypass: A review of clinical investigations. Chest, 121(3 SUPPL.), 921–931. https://doi.org/10.1378/chest.121.3.921
II. Boonen, E., Gunst, J., & van den Berghe, G. (2022). Critical illness-induced corticosteroid insufficiency: What it is not and what it could be. Journal of Clinical Endocrinology and Metabolism, 107(7), 2057–2064. https://doi.org/10.1210/clinem/dgac201
III. Marik, P. E., Pastores, S. M., Annane, D., Meduri, G. U., Sprung, C. L., Arlt, W., Keh, D., Briegel, J., Beishuizen, A., Dimopoulou, I., Tsagarakis, S., Singer, M., Chrousos, G. P., Zaloga, G., Bokhari, F., & Vogeser, M. (2008). Recommendations for the diagnosis and management of corticosteroid insufficiency in critically ill adult patients: Consensus statements from an international task force by the American College of Critical Care Medicine. Critical Care Medicine, 36(6), 1937–1949. https://doi.org/10.1097/CCM.0b013e31817603ba
IV. Annane, D., Pastores, S. M., Rochwerg, B., Arlt, W., Balk, R. A., Beishuizen, A., Briegel, J., Carcillo, J., Christ-Crain, M., Cooper, M. S., Marik, P. E., Meduri, G. U., Olsen, K. M., Rodgers, S., Russell, J. A., & van den Berghe, G. (2017). Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part I): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Intensive Care Medicine, 43(12), 1751–1763. https://doi.org/10.1007/s00134-017-4919-5
V. Manosroi, W., & Atthakomol, P. (2023). Is preoperative adrenal insufficiency screening necessary for cardiovascular thoracic surgery patients? Medicina (Lithuania), 59(1).
https://doi.org/10.3390/medicina59010152
VI. Pasero, D., Berton, A. M., Motta, G., Raffaldi, R., Fornaro, G., Costamagna, A., Toscano, A., Filippini, C., Mengozzi, G., Prencipe, N., Zavattaro, M., Settanni, F., Ghigo, E., Brazzi, L., & Benso, A. S. (2021). Neuroendocrine predictors of vasoplegia after cardiopulmonary bypass. Journal of Endocrinological Investigation, 44(7), 1533–1541.
https://doi.org/10.1007/s40618-020-01465-5
VII. Síndrome de baja gasto cardíaco en el posoperatorio de cirugía cardíaca. (2020). Revista Uruguaya de Cardiología, 35(5).
https://doi.org/10.29277/cardio.35.3.18
VIII. Pastores, S. M., Annane, D., & Rochwerg, B. (2018). Guidelines for the diagnosis and management of critical illness-related corticosteroid insufficiency (CIRCI) in critically ill patients (Part II): Society of Critical Care Medicine (SCCM) and European Society of Intensive Care Medicine (ESICM) 2017. Critical Care Medicine, 46(1), 146–148.