Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report
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(2020) 15:275
CASE REPORT
Open Access
Antiphospholipid syndrome and valvular heart disease, a complex scenario of thrombotic events, a case report Santiago A. Endara1*, Gerardo A. Dávalos1, Christian H. Fierro2, Vladimir E. Ullauri2 and Gabriel A. Molina3
Abstract Background: Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with thrombotic events, myocardial infarction, and valvular heart disease. During valvular replacement surgery, the high risk of thrombosis combined with the operative risks in these specific groups of patients poses a challenge to the medical team. Case presentation: We present a case of a female patient with APS and mixed aortic valve disease. During surgery, she suddenly developed complete cardiac arrest. Three months later, after she recovered, and while she was still on close follow up, a thrombotic event caused myocardial infarction. After prompt and precise treatment, the patient successfully recovered; one year after surgery patient is doing well. Conclusion: Adequate surgical technique along with optimal anticoagulation strategies and long term follow up are of paramount importance to ensure an uneventful recovery. A multidisciplinary team is required to manage these complex scenarios and high-risk patients. Keywords: Antiphospholipid syndrome, Thrombus, Coronaries arteries, Aortic valve replacement
Background Antiphospholipid antibodies are a heterogeneous group of autoantibodies that have clear associations with thrombosis [1]. Anticoagulation is a vital part of APS treatment as thromboembolic events can cause severe morbidity and mortality. When APS damage a heart valve, surgery becomes a challenging situation [1, 2]. Perioperative treatment and surgical planning become critical steps as the medical team must be adequately qualified to face possible complications and give the necessary long-term treatment and follow up [1, 3]. This work has been reported in line with the CARE criteria [4].
* Correspondence: [email protected] 1 Department of Surgery Division of Cardiothoracic Surgery, Hospital Metropolitano, Av. Mariana de Jesús Oe7/47 y Conclina, Edificio Diagnóstico 2000 tercer piso 3/3, Quito, Ecuador Full list of author information is available at the end of the article
Case presentation Patient is a petite 35-year-old vegan female with past medical history of systemic lupus erythematosus (SLE), antiphospholipid syndrome (APS), and deep vein thrombosis complicated with pulmonary embolism for which she received rivaroxaban. On routine medical examination, while she was completely asymptomatic, a holosystolic murmur was detected, thus, echocardiography was requested. It revealed a dilated left ventricle with mild hypertrophy and an ejection fraction of 58%. Her aortic leaflets were thickened with limited mobility, her maximum aortic velocity was 4.36 m/s, and the mean gradient was 45 mmHg. A severe regurgitant flow was at the aortic valve confirming severe aortic insufficiency (AI) and moderate aortic stenosis (AS). Mixed aortic valve disease
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