Transient Unilateral Lower Limb Palsy after Open Surgery Thoraco-Abdominal Aorta Repair

Abstract

Paraplegia is one of the most devastating complication after Thoraco-abdominal Aorta (TAA) repair both in open surgery and in endovascular procedure, caused by critical obstruction to blood perfusion of the Spinal Cord.Spinal Cord Ischemia (SCI) may be due to hemodynamic impairment and/or to segmental artery occlusion during aortic clamping [1,2].We report a case of chronically dissected Thoraco-abdominal Aortic Aneurysm (TAAA) which showed unilateral transient neurological impairment of the left lower limb, postoperatively. KeywordsSpinal cord injury, Aorta, Surgery chronic obstructive pulmonary disease (COPD) with FEV1/FVC ratio 0.43 and FEV1 1.12 L (44%).The pre-operative echocardiogram showed: Mild hypertrophy of left ventricle walls (13-14 mm), left ventricle end-diastolic volume at upper limit (LVEDVi = 74 ml/ m 2 ), inferior wall and interventricular septum were akinetic providing a reduced ejection fraction (LVEF 0.38) that did ameliorate at dobutamine echo-stress (LVEF 0.47); furthermore it showed mild aortic valve stenosis (medium pressure gradient 20 mmHg with valve area 1.2 cm 2 ).He underwent general anesthesia that was inducted by Midazolam 5 mg iv, Fentanyl 200 mcg iv. After myorelaxation with cis-Atracurium 12 mg iv a double-lumen endotracheal tube n.41 was inserted to connect the patient's airways to mechanical ventilator (Vt 560; respiratory rate 12; positive end-expiratory pressure 5 cm H 2 O); he received a gas mixture of oxygen/air (FiO 2 40-60%) and Sevoflurane 1-2%, as appropriate. Myorelaxation continued with cis-Atracurium 1 mg/kg/h. Remifentanil 0.1-0.2 mcg/kg/min was administered.