A Case of Double Valve Replacement with Antiphospholipid Syndrome

(Department of Cardiovascular Surgery, Toyama Prefectural Central Hospital, Toyama, Japan)

Hiroaki Yusa Yasushi Nishiya Akira Murata
Norihiko Saitoh Shuichi Hoshino
A 39-year-old woman was found to have a heart murmur by a medical examination at age 37. During a checkup at our hospital, echocardiography revealed mild aortic valve regurgitation (AR) and mild mitral valve regurgitation (MR). When she was 39 years old, echocardiography revealed severe MR and moderate AR. Based on preoperative examinations, antiphospholipid syndrome (APS) was diagnosed. Therefore, she received high-dose prednisolone therapy and underwent plasma exchange before the surgery. We performed double valve replacement using a bioprosthetic valve. On the first postoperative day (POD1), the number of platelets suddenly decreased. We diagnosed catastrophic APS, and treated her with high-dose prednisolone, high-dose immunoglobulin and plasma exchange. Her blood platelet gradually increased on POD3. Although she needed time for rehabilitation, she was discharged from our hospital on POD88. APS can cause a catastrophic event triggered by an operation. Therefore, stringent pre- and postoperative management is necessary in patients with APS.
@Jpn. J. Cardiovasc. Surg. 36: 329-332 (2007)