Successful aortic valve replacement in severe pancytopenia related to myelodysplastic syndrome

Abstract

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.

Aortic Valve Replacement and Graft Replacement of the Ascending Aorta Using Deep Hypothermic Circulatory Arrest in a Patient with Myelodysplastic Syndrome

“…[4][5][6] Only 3 cases, including the case described here, were RAEB; the others were RA, with a better prognosis and a 5-year survival of about 50 %. 2,3) Only one report 7) of a complex operation requiring DHCA, was for TAA of ascending and AR, where the bleeding tendency was so severe and re-exploration to control the surgical bleeding was performed.…”

Aortic Valve Replacement in a Patient With Myelodysplastic Syndrome and Interstitial Pneumonia

“…There are several reports of cardiac surgery in patients with MDS: 3 cases of RA and 1 of RAEB. [5][6][7][8] In the patients with the RA or RARS of MDS, it was possible to perform surgical treatment with replacement of blood cell components. Therefore, we prepared for bleeding and impaired oxygen transportation by supplementing the patient's blood components.…”

“…Myelodysplastic syndrome (MDS) is clinical condition with pancytopenia caused by dysplasia of the bone marrow. Because the patients with MDS has risks of bleeding and infection, 1,[5][6][7][8][9] cardiac surgery using extracorporeal circulation (ECC) increases those risks, which affect morbidity and mortality. 2 Interstitial pneumonia is also a risk factor in cardiac surgery, because it exacerbates lung function after surgery, and steroid therapy for interstitial pneumonia associated with scleroderma is necessary, but that also increases the morbidity and mortality.…”

Mitral and Tricuspid Valvuloplasty in a Patient With Myel-Odysplastic Syndrome

“…[6][7][8] Samo je nekoliko pojedinačnih prikaza bolesnika s mijelodisplastičnim sindromom kod kojih je učinjen kirurški zahvat rekonstrukcije aortalne ili mitralne valvule, jer opsežan zahvat često dovodi do krvarenja te infektivnih komplikacija. [9][10][11][12][13][14][15][16][17][18][19] Dosad je u literaturi opisan samo jedan prikaz istodobnog izvođenja mitralne i trikuspidalne valvuloplastike.…”

“…Kardiokirurški zahvati u bolesnika s MDS-om rijetki su, uglavnom je riječ o aortokoronarnom premoštenju ili zamjeni aortalne ili mitralne valvule. [6][7][8][9][10][11][12][13][14][15][16][17][18] Operativni je postupak kompleksan. Ako bolesnik i preživi zahvat, postoji mogućnost postoperativnih komplikacija, kao i pogoršanja MDS-a.…”