title: Hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis.
abstract: We report a case of hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis. A 77-year-old male with severe aortic valve stenosis and 19 years hemodialysis underwent aortic valve replacement. Postoperatively, the patient died of hemodynamic deterioration. Autopsy findings showed massive, whole-body edema and mixed systemic amyloidosis (dialysis-related and AA amyloidosis). Clinical and autopsy findings implied that hemodynamic deterioration was caused by increased vascular permeability. The amyloid deposit to the vessel causes inflammatory changes and increases vascular permeability. Mixed systemic amyloidosis occurs very rarely and could increases vascular permeability even more than each single type of amyloidosis. Systemic amyloidosis may be a risk factor for hemodynamic deterioration after cardiac surgery. Patients with longtime hemodialysis and a history associated with dialysis-related amyloidosis would have at least single systemic amyloidosis, which should be considered a contraindication to cardiac surgery with cardiopulmonary bypass.
authors.affiliation: Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, 1 jo 8 chome 3-18, Toyohira-ku, Sapporo, Japan. sekky48@yahoo.co.jp.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Seki
authors.affiliation: Department of Pathology, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, Sapporo, Japan.
authors.forename: Atsuo
authors.initials: A
authors.lastname: Hattori
authors.affiliation: Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, 1 jo 8 chome 3-18, Toyohira-ku, Sapporo, Japan.
authors.forename: Toshihito
authors.initials: T
authors.lastname: Yoshida
mesh_terms: D000368:Aged; D000686:Amyloidosis / Q000150:complications*; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D017809:Fatal Outcome; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006439:Hemodynamics; D006801:Humans; D008297:Male
keywords: AA amyloidosis; Aortic valve replacement; Dialysis-related amyloidosis; Mixed systemic amyloidosis; Permeability