Ochronosis is a
rare disease. Usually symptoms appear in the third, fourth, or later decade of life. The most common symptom is
arthropathy, but cardiovascular system can be involved in this disease. A 71-year-old man with
ochronosis was scheduled for
total hip arthroplasty. Preoperatively, echocardiogram revealed
aortic valve stenosis,
mitral valve stenosis, and hypokinesis on antero-septal, lateral and posterior walls. Coronary angiogram revealed 50-75%
stenosis of the left anterior descending coronary artery (segment 7) and 100%
stenosis of the left circumflex artery (segment 15). Before the induction of
general anesthesia, electrocardiogram showed first-degree
atrioventricular block. After the induction of
general anesthesia, blood pressure decreased markedly.
Phenylephrine administration and rapid infusion of extracellular fluid failed to increase blood pressure. Thus, we started to administer
dopamine at an infusion rate of 10 microg x kg(-1) x min(-1) which increased blood pressure effectively, but electrocardiogram showed second-degree
atrioventricular block (Mobitz type II). We started rapid infusion of a plasma substitute, and gradually decreased the infusion rate of
dopamine to 4 microg x kg(-1) x min(-1). Then electrocardiogram returned to first-degree
atrioventricular block. We estimated that second-degree
atrioventricular block in this patient might have been exaggerated by
dopamine at least in part.