Postoperative usage of tolvaptan in a patient with aortic valve stenosis complicated by Child-Pugh classification B liver cirrhosis and hepatic edema

We report the case of an 80-year-old woman with postoperative congestive heart failure (CHF) complicated by Child-Pugh classification B liver cirrhosis and hepatic edema successfully treated with tolvaptan. The patient suffered from liver cirrhosis and underwent partial hepatectomy for a hepatocellular carcinoma diagnosed together with a severe aortic valve stenosis. Aortic valve replacement was performed under cardiopulmonary bypass. The postoperative course was uneventful until CHF and hepatic edema symptoms appeared on postoperative day (POD) 2. The symptoms were treated with intravenous human atrial natriuretic peptide and oral diuretics. As the condition showed no improvement, oral tolvaptan was administered on POD 11 and thereafter, which markedly improved the symptoms. This is apparently the first report describing the effectiveness of tolvaptan for the postoperative management of fluid balance in a patient with cardiac and liver dysfunction.