Skip to main content
SpringerLink
Log in

Hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis

  • Case Report
  • Published:
General Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. Gejyo F, Narita I. Current clinical and pathogenetic understanding of beta2-m amyloidosis in long-term haemodialysis patients. Nephrology. 2003;8:45–9.

    Article  Google Scholar 

  2. Obici L, Perfetti V, Palladini G, Moratti R, Merlini R. Clinical aspects of systemic amyloid diseases. Biochim Biophys Acta. 2005;1753:11–22.

    Article  CAS  PubMed  Google Scholar 

  3. Fernandez-Alonso J, Rios-Camacho C, Valenzuela-Castano A, Hernanz-Mediano W. Mixed systemic amyloidosis in a patient receiving long term haemodialysis. J Clin Pathol. 1994;47:560–1.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Ehlerding G, Schaeffer J, Drommer W, Miyata T, Koch KM, Floege J. Alterations of synovial tissue and their potential role in the deposition of beta2-microglobulin-associated amyloid. Nephrol Dial Transpl. 1998;13:1465–75.

    Article  CAS  Google Scholar 

  5. Horst M, Mehlhorn U, Hoerstrup SP, Suedkamp M, de Vivie ER. Cardiac surgery in patients with end-stage renal disease: 10-year experience. Ann Thorac Surg. 2000;69:96–101.

    Article  CAS  PubMed  Google Scholar 

  6. Umezu K, Saito S, Yamazaki K, Kawai A, Kurosawa H. Cardiac valvular surgery in dialysis patients: comparison of surgical outcome for mechanical versus bioprosthetic valves. Gen Thorac Cardiovasc Surg. 2009;57:197–202.

    Article  PubMed  Google Scholar 

  7. Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Hypothermia, circulatory arrest, and cardiopulmonary bypass. In: Kirklin/Barratt-Boyes cardiac surgery. 3rd ed. Philadelphia: Churchill Livingstone; 2003.

  8. Schultz RT. Role of altered vascular permeability amyloid formation. Am J Pathol. 1977;86:321–41.

    CAS  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiovascular Surgery, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, 1 jo 8 chome 3-18, Toyohira-ku, Sapporo, Japan

    Tatsuya Seki & Toshihito Yoshida

  2. Department of Pathology, Japan Community Health Care Organization (JCHO) Hokkaido Hospital, Sapporo, Japan

    Atsuo Hattori

Authors
  1. Tatsuya Seki
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Atsuo Hattori
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Toshihito Yoshida
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tatsuya Seki.

Ethics declarations

Conflict of interest

The authors have declared that no conflict of interest exists.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Seki, T., Hattori, A. & Yoshida, T. Hemodynamic deterioration after aortic valve replacement in a patient with mixed systemic amyloidosis. Gen Thorac Cardiovasc Surg 65, 470–473 (2017). https://doi.org/10.1007/s11748-016-0703-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11748-016-0703-7

Keywords

Search

Navigation