PMID- 36960260
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20230325
IS  - 2168-8184 (Print)
IS  - 2168-8184 (Electronic)
IS  - 2168-8184 (Linking)
VI  - 15
IP  - 2
DP  - 2023 Feb
TI  - A Case of Post-operative Jaundice After Cardiac Surgery.
PG  - e35190
LID - 10.7759/cureus.35190 [doi]
LID - e35190
AB  - Hyperbilirubinemia is a common gastrointestinal complication seen post-cardiac 
      surgery. Here, we describe a case of a 72-year-old male with a past medical 
      history of chronic obstructive pulmonary disease, chronic kidney disease (CKD), 
      pulmonary hypertension, and valvular heart disease with severe aortic stenosis, 
      severe mitral and tricuspid regurgitations who underwent elective aortic valve 
      replacement (AVR), mitral valve replacement (MVR), and tricuspid valve (TV) 
      repair; in addition, he required left thoracotomy for the repair of pulmonary 
      artery perforation from a Swan-Ganz catheter that resulted in a large left 
      pleural bleed. Post-operatively, he developed severe jaundice, which was 
      predominantly conjugated that peaked at 24 mg/dL. He also required multiple blood 
      products' transfusion in the perioperative period and was supported temporarily 
      with hemodialysis for acute kidney injury superimposed on his CKD. He underwent 
      extensive evaluation for jaundice, which included ultrasound of the liver, 
      hepatobiliary iminodiacetic (HIDA) scan, and magnetic resonance 
      cholangiopancreatography (MRCP), which were all normal. The patient eventually 
      got better and was discharged from the hospital. The hyperbilirubinemia slowly 
      got better without any specific therapy and on his follow-up visit to the office 
      following discharge, his bilirubin level was found completely normalized. 
      Although most cases of post-cardiac surgery hyperbilirubinemia resolve without 
      any specific therapy, the occurrence is not completely benign since it can 
      increase morbidity and mortality. It is paramount that intensivists and 
      cardiothoracic surgeons caring for these patients are aware of this occurrence to 
      prevent unnecessary diagnostic evaluation. Most early cases of hyperbilirubinemia 
      are transient and do not usually increase morbidity and mortality. In the late 
      cases, infectious etiology resulting in sepsis needs to be entertained early and 
      treated aggressively.
CI  - Copyright (c) 2023, Alabi et al.
FAU - Alabi, Fortune O
AU  - Alabi FO
AD  - Pulmonary Medicine, Critical Care and Sleep Medicine, Florida Lung, Asthma & 
      Sleep Specialists, Orlando, USA.
FAU - Alabi, Christopher O
AU  - Alabi CO
AD  - Internal Medicine, HCA East Florida Westside Hospital/Northwest Hospital, 
      Plantation, USA.
AD  - Internal Medicine, Florida Lung, Asthma & Sleep Specialists, Orlando, USA.
FAU - Waldon, Brent
AU  - Waldon B
AD  - Cardiovascular Surgery, AdventHealth Orlando, Orlando, USA.
FAU - Umeh, Fred C
AU  - Umeh FC
AD  - Pulmonary Medicine and Critical Care Medicine, Florida Lung, Asthma & Sleep 
      Specialists, Orlando, USA.
FAU - Palmer, George
AU  - Palmer G
AD  - Cardiovascular Surgery, AdventHealth Orlando, Orlando, USA.
LA  - eng
PT  - Case Reports
DEP - 20230219
PL  - United States
TA  - Cureus
JT  - Cureus
JID - 101596737
PMC - PMC10030160
OTO - NOTNLM
OT  - blood transfusion
OT  - cardio-pulmonary bypass surgery
OT  - hyperbilirubinemia
OT  - mitral valve replacement
OT  - post-cardiac surgery hyperbilirubinemia
OT  - tricuspid valve replacement
OT  - valvular heart disease
COIS- The authors have declared that no competing interests exist.
EDAT- 2023/03/25 06:00
MHDA- 2023/03/25 06:01
PMCR- 2023/02/19
CRDT- 2023/03/24 02:24
PHST- 2023/02/19 00:00 [accepted]
PHST- 2023/03/24 02:24 [entrez]
PHST- 2023/03/25 06:00 [pubmed]
PHST- 2023/03/25 06:01 [medline]
PHST- 2023/02/19 00:00 [pmc-release]
AID - 10.7759/cureus.35190 [doi]
PST - epublish
SO  - Cureus. 2023 Feb 19;15(2):e35190. doi: 10.7759/cureus.35190. eCollection 2023 
      Feb.