Saku Kosuke, Takagi Kazuyoshi, Hirata Masahiro, Arinaga Koichi, Tayama Eiki
Division of Cardiovascular Surgery, Department of Surgery, Kurume University, Kurume, JPN.
Cureus. 2024 Nov 29;16(11):e74771. doi: 10.7759/cureus.74771. eCollection 2024 Nov.
The outcomes of cardiac surgery in patients with hematologic disorders are significantly worse. However, details of the clinical course of each hematologic disease remain unclear. Myelodysplastic syndrome (MDS) presents with progressive pancytopenia that has the risk of infection, hemorrhage, and transformation to acute myelogenous leukemia. A 65-year-old woman who had a history of surgery for Stanford type A acute aortic dissection presented rapidly decreasing platelets and the appearance of erythroblasts in peripheral blood. A bone marrow biopsy was performed. The day after the biopsy, an impending rupture of the pseudoaneurysm at the graft anastomosis site was found accidentally by computed tomography. Although she underwent aortic root replacement, she had recurrent thrombocytopenia and anemia, along with unexpected bleeding complications after surgery. After she was diagnosed with high-risk MDS, the management was challenging, including the decision of the indication for blood transfusion and treatments for some complications. Ultimately, she died due to infection. This report provides valuable insights into the detailed postoperative course of cardiac surgery in a patient with high-risk MDS.
血液系统疾病患者心脏手术的预后明显更差。然而，每种血液系统疾病的临床病程细节仍不清楚。骨髓增生异常综合征（MDS）表现为进行性全血细胞减少，有感染、出血以及转化为急性髓系白血病的风险。一名65岁女性，有斯坦福A型急性主动脉夹层手术史，外周血血小板迅速减少且出现有核红细胞。进行了骨髓活检。活检后第二天，计算机断层扫描意外发现移植吻合部位假性动脉瘤即将破裂。尽管她接受了主动脉根部置换术，但术后仍反复出现血小板减少和贫血，并伴有意外的出血并发症。在她被诊断为高危MDS后，治疗颇具挑战性，包括输血指征的决策和一些并发症的治疗。最终，她因感染死亡。本报告为高危MDS患者心脏手术详细的术后病程提供了有价值的见解。
