A Successful Surgical Case of Severe Aortic Regurgitation Associated with Nonbacterial Thrombotic Endocarditis in the Patient of Cryoglobulinemia
- VernacularTitle:クリオグロブリン血症性血管炎患者に発症した非細菌性血栓性心内膜炎による大動脈弁逆流症に対して外科治療を行った1例
- Author:
Daiki KATO
1
;
Yosuke TANAKA
1
;
Makoto KUSAKIZAKO
1
;
Ryouta TAKAHASHI
1
;
Koki YOKAWA
1
;
Tomonori HIGUMA
1
;
Hidefumi OBO
1
;
Hidetaka WAKIYAMA
1
Author Information
- Keywords: cryoglobulinemia; preoperative plasmapheresis; tepid blood cardioplegia
- From:Japanese Journal of Cardiovascular Surgery 2024;53(6):333-338
- CountryJapan
- Language:Japanese
- Abstract: A 74-year-old man, with a medical background of cryoglobulinemia, had been undergone nonbacterial thrombotic endocarditis with immunotherapy spanning three months. Following a year and three months, he has presented to our institution experiencing acute decompensated heart failure attributable to severe aortic regurgitation （AR），moderate mitral regurgitation （MR），and severe tricuspid regurgitation （TR）．Transesophageal echocardiography revealed aortic valve cusps destruction and anterior mitral valve leaflet vegetation. The potential complications of leukocytoclastic or necrotizing vasculitis due to hypothermic cardiopulmonary bypass in cryoglobulinemia patients were addressed preemptively through preoperative plasmapheresis. During the procedure, tepid core cooling cardiopulmonary bypass at 33℃ and tepid blood cardioplegia solution at 30℃ were employed to mitigate the risk of vasculitis. Urgent aortic valve replacement, mitral vegetation resection, and tricuspid annuloplasty were performed, and the patient was discharged on the 23rd postoperative day without any untoward events.
