ARTERIAL-HYPOTENSION AFTER CARDIAC-SURGER Y - RESISTANCY TO THERAPY

Adrenalin insufficiency associated with adrenal hemorrhage, is a rare complication after cardiac surgery in neonates. A boy suffering from t ransposition of the great arteries, who had an arterial switch-operati on on day three of his life, aquired a bilateral adrenal hemorrhage. C linically the situation resembled a septic shock. Despite large doses of catecholamines, he continued to have severe arterial hypotension, a nuria, and kyperkalemia. The clinical condition did not change, althou gh sepsis specific therapy was initiated. Consequently adrenal insuffi ciency, as a possible postoperative complication, was considered and p rednisolon, initially in a dose of 15 mg/kg/d, was administered. The c linical condition improved dramatically. The diagnosis could be confir med by ultrasound examination and determination of cortisol and ACTH p lasma levels. Adrenal insufficiency was only transitory, adrenal sonog raphy on day 135 returned to normal. The surgical procedure on heart-l ung bypass, the obligatory anticoagulation and the perioperative stres s have to be considered as pathogenetic factors.