Successful aortic valve replacement in severe pancytopenia related to myelodysplastic syndrome.
We report a 60-year-old man with myelodysplastic syndrome (MDS) whose aortic valve was replaced successfully. He suffered from dyspnea on exertion and was confirmed by echocardiography and cardiac catheterization to have severe aortic stenosis. A peripheral blood examination showed pancytopenia and a bone marrow examination showed MDS with a subtype of refractory anemia with excess blasts. His preoperative neutrophil count was 468/mm3, hemoglobin 9.8 g/dl, and platelet count 27,000/mm3. We conducted aortic valve replacement (AVR) using a bioprosthesis in July 2001. Pre- and postoperatively, we injected granulocyte colony-stimulating factor to keep the neutrophil count at 2,000/mm3 or more. We also transfused platelet concentrate and infused tranexamic acid. Despite potential risks of infection and bleeding, the AVR involved no significant complications. Careful preoperative planning thus plays an important role in managing such cases.
Kurisu
Kazuhiro
K
Department of Cardiovascular Surgery, Kitakyushu Municipal Medical Center, 2-1-1 Bashaku, Kokurakita-ku, Kitakyushu 802-0077, Japan.
Ochiai
Yoshie
Y
Kajiwara
Takashi
T
Tominaga
Ryuji
R
D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000601:surgery; D001705:Bioprosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications*; D010198:Pancytopenia / Q000150:complications* / Q000628:therapy