Sezai Akira, Akiyama Kenji, Fukushima Seiji, Kashiwazaki Satoshi, Shiono Motomi, Horikoshi Akira, Nakamura Takashi, Hemmi Akihiro
Department of Cardiovascular Surgery, Nihon University Nerima Hikarigaoka Hospital, 30-1 Oyaguchi-kamimachi, Itabashi-ku, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2011;17(6):618-23. doi: 10.5761/atcs.cr.10.01647. Epub 2011 Jul 27.
A 71-year-old woman with idiopathic thrombocytopenic purpura (ITP), who had been treated with steroid and cyclosporine, was admitted in an emergency with fever and dyspnea. The diagnosis was mitral regurgitation due ton infective endocarditis. Although she received treatments for infection and cardiac failure, the cardiac failure could not be controlled. After high-dose γ-globulin therapy, an emergency operation was performed during the active phase of infective endocarditis. Rapid platelet transfusion was administered after weaning from extracorporeal circulation. She recovered and was discharged without postoperative bleeding and re-infection.The treatment course of elective cardiac surgery complicated with ITP has been established, but the course of emergency surgery has not been established because of the small number of cases reported. Since few patients have undergone emergency surgery for active infective endocarditis, we had difficulty in deciding the time of surgery and treatment for increasing the number of platelets before surgery, it was considered that the case provided us with useful suggestion for the future treatment for urgent surgery complicated with ITP.
一名71岁患有特发性血小板减少性紫癜（ITP）的女性，曾接受类固醇和环孢素治疗，因发热和呼吸困难紧急入院。诊断为感染性心内膜炎导致的二尖瓣反流。尽管她接受了抗感染和心力衰竭治疗，但心力衰竭仍无法得到控制。在大剂量γ球蛋白治疗后，于感染性心内膜炎活动期进行了急诊手术。体外循环撤机后快速输注血小板。她康复出院，术后无出血及再次感染。择期心脏手术合并ITP的治疗方案已确立，但急诊手术方案因报道病例数少尚未确立。由于很少有患者因活动性感染性心内膜炎接受急诊手术，我们在确定手术时机以及术前增加血小板数量的治疗方法上存在困难，认为该病例为未来ITP合并急诊手术的治疗提供了有益的建议。
