Diasty Mohammad El, Cuenca Jose
Cardiac Surgery Department, Kingston Health Science Centre, 76 Stuart Street, Kingston, ON K7L 2V7, Canada.
Cardiac Surgery Department, Hospital San Rafael, Ls Jubias, 82, 15009 A Coruna, Spain.
Eur Heart J Case Rep. 2021 Mar 14;5(3):ytab060. doi: 10.1093/ehjcr/ytab060. eCollection 2021 Mar.
Calciphylaxis is a rare life-threatening condition that is characterized by calcification of small blood vessels and soft tissues. This condition is classically described in uraemic patients with end-stage renal failure who are on dialysis or had previous renal transplant. It has also been reported in non-uraemic patients and those who are on warfarin therapy. It is typically associated with high calcium/phosphorus product. Patients classically present with painful skin lesion that evolve into painful ulcers. There are multiple risk factors that were reported to trigger or worsen calciphylaxis. Treatment is a multidisciplinary approach that involves elimination of risk factors, wound management, pain control, and optimization of calcium/phosphorus metabolism. Reported mortality rates are very high especially in the uraemic group.
Here we present a case of a patient, who is on chronic renal dialysis for stage renal failure, who underwent mechanical mitral valve replacement and tricuspid valve repair. In the perioperative period, she was exposed to multiple risk factors that are known to potentially trigger prophylaxis. In the early postoperative period, she developed new-onset rapidly deteriorating skin lesions and the histopathological diagnosis confirmed calciphylaxis. Her treatment plan included pain control, frequent wound care, and optimization of nutritional and metabolic status.
Calciphylaxis is a very serious condition that is usually associated with poor outcome. In this case, we discuss the unusual presentation of this condition with particular emphasis on the multiple perioperative risk factors that can potentially trigger the onset of calciphylaxis in postoperative cardiac patients. We also discuss the epidemiology, pathogenesis, diagnosis, histopathological findings, and different lines of treatment of this serious condition and the potential preventative strategies.
钙化防御是一种罕见的危及生命的疾病，其特征为小血管和软组织钙化。这种疾病经典地描述于接受透析或曾接受肾移植的终末期肾衰竭尿毒症患者中。也有报道称在非尿毒症患者以及接受华法林治疗的患者中出现。它通常与高钙/磷乘积相关。患者通常表现为疼痛性皮肤病变，随后发展为疼痛性溃疡。据报道，有多种危险因素可引发或加重钙化防御。治疗是一种多学科方法，包括消除危险因素、伤口处理、疼痛控制以及优化钙/磷代谢。报道的死亡率非常高，尤其是在尿毒症组。
在此，我们呈现一例因肾衰竭接受慢性肾透析的患者，该患者接受了机械二尖瓣置换术和三尖瓣修复术。在围手术期，她暴露于多种已知可能引发钙化防御的危险因素中。术后早期，她出现了新发的迅速恶化的皮肤病变，组织病理学诊断证实为钙化防御。她的治疗方案包括疼痛控制、频繁伤口护理以及优化营养和代谢状态。
钙化防御是一种非常严重的疾病，通常预后不良。在本病例中，我们讨论了这种疾病的不寻常表现，特别强调了多种围手术期危险因素，这些因素可能在心脏术后患者中引发钙化防御的发作。我们还讨论了这种严重疾病的流行病学、发病机制、诊断、组织病理学发现、不同的治疗方法以及潜在的预防策略。
