Kansaku Rei, Kuwaki Kenji, Amano Atsushi, Inaba Hirotaka, Tambara Keiichi, Yamamoto Taira, Sakakibara Naoki
Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan.
Ann Thorac Cardiovasc Surg. 2012;18(3):259-61. doi: 10.5761/atcs.cr.11.01753.
A 60-year-old man was admitted to our hospital because of aortic stenosis with a peak pressure gradient of 61 mmHg, moderate aortic regurgitation, and a dilatation of the ascending aorta of 50 mm in diameter, which had grown 5 mm in 2 years. Because of severe aortic stenosis with a bicuspid valve and fast progression of the ascending aorta in size, replacements of both the aortic valve and the ascending aorta were planned.He had experienced severe acute renal failure with hemolysis because of cold agglutinin one year before the operation. The hemoglobin had decreased to 4.3 g/dL during hemolytic attack. His titer of cold agglutinin was extremely high. The titer of cold agglutinin has kept above than 1:131072 at 4 degree Celsius. It once increased to 1:524288.Both the replacement of the aortic valve and the ascending aorta under normothermic cardiopulmonary bypass using intermittent warm blood cardioplegia were completed uneventfully. He was discharged from the hospital on postoperative day 11.
一名60岁男性因主动脉瓣狭窄伴峰值压力阶差61 mmHg、中度主动脉瓣反流以及升主动脉直径扩张至50 mm（2年内增长了5 mm）而入住我院。由于严重的主动脉瓣狭窄合并二叶式瓣膜以及升主动脉大小快速进展，计划同时置换主动脉瓣和升主动脉。他在手术前一年因冷凝集素导致严重的急性肾衰竭并伴有溶血。溶血发作期间血红蛋白降至4.3 g/dL。他的冷凝集素滴度极高。在4摄氏度时，冷凝集素滴度一直保持在高于1:131072，曾一度升至1:524288。使用间歇性温血心脏停搏液在常温体外循环下顺利完成了主动脉瓣和升主动脉的置换。他于术后第11天出院。
