Sekine Yuji, Kusuhara Takayoshi, Ann Kenta, Nakatsuka Daisuke, Iwakura Atsushi, Yamanaka Kazuo
Department of Cardiovascular Surgery, Tenri-yorozu Hospital, Tenri, Japan.
Kyobu Geka. 2011 Feb;64(2):154-7.
An 83-year-old woman, who had suffered from idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital because of cardiac heart failure and chest pain. The platelet was 42 x 10(4) in microl. Echocardiography revealed moderate aortic stenosis and regurgitation and left ventricular dysfunction. Preoperatively, we tapered oral steroid and administered high-dose immunoglobulin intravenously. Intraoperatively, we found quadricuspid aortic valve and the rudimentary accessory cusp was located between the right coronary cusp and noncoronary cusp. Aortic valve replacement was performed with bioprosthetic valve. The postoperative course was uneventful. Postoperative echocardiography revealed no perivalvular leakage. Preoperative administration of high-dose immunoglobulin and intraoperative platelet transfusion is very effective to minimize hemorrhagic complication in patients with ITP. We herein report an extremely rare quadricuspid aortic valve complicated with ITP.
一名83岁患有特发性血小板减少性紫癜（ITP）的女性因心力衰竭和胸痛入住我院。血小板计数为42×10⁴/微升。超声心动图显示中度主动脉瓣狭窄和反流以及左心室功能障碍。术前，我们逐渐减少口服类固醇药物剂量并静脉注射大剂量免疫球蛋白。术中，我们发现为四叶式主动脉瓣，原始附属瓣叶位于右冠状动脉瓣叶和无冠状动脉瓣叶之间。使用生物人工瓣膜进行了主动脉瓣置换术。术后过程顺利。术后超声心动图显示无瓣周漏。术前给予大剂量免疫球蛋白和术中输注血小板对于将ITP患者的出血并发症降至最低非常有效。我们在此报告一例极为罕见的合并ITP的四叶式主动脉瓣病例。
