Severe Aortic Stenosis in a Patient with Cryoglobulinemia

OKAMOTO Takashi, KIMURA Tatsunori, KUME Masazumi

doi:10.3919/jjsa.78.1248

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Other Title

クリオグロブリン血症を合併した重症大動脈弁狭窄症の1例
症例クリオグロブリン血症を合併した重症大動脈弁狭窄症の1例
ショウレイクリオグロブリンケッショウオガッペイシタジュウショウダイドウミャクベンキョウサクショウノ 1レイ

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Abstract

An 80-year-old man was evaluated for exertional dyspnea. Echocardiography showed an aortic valve orifice area of 0.51 cm² and a mean left ventricular-aortic pressure gradient of 41 mmHg (maximum : 93 mmHg). Severe aortic stenosis was diagnosed. Aortic valve replacement (AVR) under cardiopulmonary bypass was planned, but the patient had a past history of cryoglobulinemic purpura.<BR>AVR is usually performed at a moderately low body temperature. But because patients with cryoglobulinemia can develop thrombosis when exposed to cold, surgery in this case was performed under normothermic cardiopulmonary bypass. Normothermic antegrade intermittent coronary perfusion and retrograde continuous coronary perfusion were also used for myocardial protection. In addition, heating with a blanket was used to maintain body temperature at ≥37°C.<BR>No serious perioperative complications occurred, no perioperative plasmapheresis was required, and the patient was discharged on postoperative day 19. This relatively rare case of severe aortic stenosis in a patient with cryoglobulinemia in whom AVR was performed under normothermic cardiopulmonary bypass is described along with a discussion of the relevant literature.

Journal

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association)

Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association) 78 (6), 1248-1251, 2017

Japan Surgical Association

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