title: [Mitral valve re-replacement for a patient with multiple myeloma].
abstract: Mitral valve re-replacement was successfully undertaken in a 70-year-old female patient with primary tissue failure of mitral bioprosthesis and multiple myeloma (MM) through right lateral thoracotomy with minimum dissection. Considering the post-operative anti-coagulant therapy, bioprosthesis was chosen in this complicated case. Patients with MM usually show a bleeding tendency associated with abnormally elevated IgG which covers the surface of coagulation factors. Safety range of serum IgG concentration in the patients with MM who require open heart surgery, have not defined yet. Excessive serum IgG leads the coagulation disorder and organ perfusion problem because of increase of blood viscosity. Those problems become serious when the serum IgG concentration exceed 2,500 mg/dl. (1) Only if serum IgG level below 2,5000 mg/dl, valve replacement will be able to perform safely with minimum dissection through the thoracotomy for patients with MM. (2) Bioprosthesis might be optionally chosen in such case (3). In case of serum IgG level over 2,500 mg/dl, preoperative plasma ex-change should be recommended.
authors.affiliation: Department of Cardiovascular Surgery, University of Tsukuba Hospital, Japan.
authors.forename: K
authors.initials: K
authors.lastname: Yamabuki
authors.forename: Y
authors.initials: Y
authors.lastname: Terada
authors.forename: Y
authors.initials: Y
authors.lastname: Yoshimura
authors.forename: T
authors.initials: T
authors.lastname: Hattori
authors.forename: T
authors.initials: T
authors.lastname: Mitsui
authors.forename: M
authors.initials: M
authors.lastname: Hori
mesh_terms: D000368:Aged; D001705:Bioprosthesis; D005260:Female; D006801:Humans; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000601:surgery; D009101:Multiple Myeloma / Q000150:complications*; D012086:Reoperation