Aortic valve replacement to a patient with high titer of cold agglutinin.
A 60-year-old man was admitted to our hospital because of aortic stenosis with a peak pressure gradient of 61 mmHg, moderate aortic regurgitation, and a dilatation of the ascending aorta of 50 mm in diameter, which had grown 5 mm in 2 years. Because of severe aortic stenosis with a bicuspid valve and fast progression of the ascending aorta in size, replacements of both the aortic valve and the ascending aorta were planned.He had experienced severe acute renal failure with hemolysis because of cold agglutinin one year before the operation. The hemoglobin had decreased to 4.3 g/dL during hemolytic attack. His titer of cold agglutinin was extremely high. The titer of cold agglutinin has kept above than 1:131072 at 4 degree Celsius. It once increased to 1:524288.Both the replacement of the aortic valve and the ascending aorta under normothermic cardiopulmonary bypass using intermittent warm blood cardioplegia were completed uneventfully. He was discharged from the hospital on postoperative day 11.
Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan. kansaku-ths@umin.ac.jp
Rei
R
Kansaku
Kenji
K
Kuwaki
Atsushi
A
Amano
Hirotaka
H
Inaba
Keiichi
K
Tambara
Taira
T
Yamamoto
Naoki
N
Sakakibara
D058186:Acute Kidney Injury / Q000209:etiology; D000744:Anemia, Hemolytic, Autoimmune / Q000097:blood / Q000150:complications*; D001021:Aortic Valve / Q000002:abnormalities / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D015415:Biomarkers / Q000097:blood; D019917:Blood Vessel Prosthesis Implantation; D002315:Cardiopulmonary Bypass; D003450:Cryoglobulins / Q000032:analysis; D006324:Heart Arrest, Induced; D006330:Heart Defects, Congenital / Q000097:blood / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome; D015854:Up-Regulation
D015415:Biomarkers; D003450:Cryoglobulins; C029443:cold agglutinins