Journal of cardiothoracic surgery · 2026
Perioperative management of a patient with comorbid immune thrombocytopenia and antiphospholipid syndrome undergoing minimally invasive mitral valve surgery.
СтатьяКлинический случайНазвание и аннотация: Перевод в очереди
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Mori Kazuki, Sako Hidenori, Kizu Kenya, Shuto Takashi, Ogata Yuko, Miyamoto Shinji
Аннотация
BACKGROUND: Although rare, immune thrombocytopenia can coexist with antiphospholipid syndrome, creating a management dilemma between maintaining hemostasis and preventing thromboembolism. Herein, we report our strategic perioperative management of a patient with this complex hematological profile who underwent minimally invasive cardiac surgery.
CASE PRESENTATION: A 55-year-old man with chronic atrial fibrillation and severe mitral regurgitation was diagnosed with immune thrombocytopenia and antiphospholipid syndrome. A minimally invasive cardiac surgery approach was chosen to minimize surgical trauma and the risk of perioperative bleeding. The mitral valve exhibited thickened chordae and leaflet retraction accompanied by verrucous excrescences, which are highly suggestive of Libman-Sacks endocarditis. Despite attempts at valve repair using annuloplasty, artificial chordae, and cleft closure, significant mitral regurgitation persisted because of extensive fibrotic changes. Consequently, the procedure was converted to mitral valve replacement with a mechanical prosthesis. Although the patient's platelet count immediately dropped to 12,000/µL postoperatively, prompt treatment with platelet transfusion and high-dose immunoglobulin therapy ensured rapid recovery. The patient was discharged without any complications, even after initiating anticoagulation therapy with warfarin.
CONCLUSION: Managing cardiac surgery in patients with comorbid immune thrombocytopenia and antiphospholipid syndrome presents a significant therapeutic challenge. Based on our experience, a minimally invasive approach combined with a strategic perioperative protocol (specifically, postponing immunoglobulin therapy until the immediate postoperative period to facilitate rapid platelet recovery alongside anticoagulation) can achieve successful outcomes while balancing the conflicting risks of thrombosis and hemorrhage.
CASE PRESENTATION: A 55-year-old man with chronic atrial fibrillation and severe mitral regurgitation was diagnosed with immune thrombocytopenia and antiphospholipid syndrome. A minimally invasive cardiac surgery approach was chosen to minimize surgical trauma and the risk of perioperative bleeding. The mitral valve exhibited thickened chordae and leaflet retraction accompanied by verrucous excrescences, which are highly suggestive of Libman-Sacks endocarditis. Despite attempts at valve repair using annuloplasty, artificial chordae, and cleft closure, significant mitral regurgitation persisted because of extensive fibrotic changes. Consequently, the procedure was converted to mitral valve replacement with a mechanical prosthesis. Although the patient's platelet count immediately dropped to 12,000/µL postoperatively, prompt treatment with platelet transfusion and high-dose immunoglobulin therapy ensured rapid recovery. The patient was discharged without any complications, even after initiating anticoagulation therapy with warfarin.
CONCLUSION: Managing cardiac surgery in patients with comorbid immune thrombocytopenia and antiphospholipid syndrome presents a significant therapeutic challenge. Based on our experience, a minimally invasive approach combined with a strategic perioperative protocol (specifically, postponing immunoglobulin therapy until the immediate postoperative period to facilitate rapid platelet recovery alongside anticoagulation) can achieve successful outcomes while balancing the conflicting risks of thrombosis and hemorrhage.