A Successful Surgical Case of Severe Aortic Regurgitation Associated with Nonbacterial Thrombotic Endocarditis in the Patient of Cryoglobulinemia

Abstract

A 74-year-old man, with a medical background of cryoglobulinemia, had been undergone nonbacterial thrombotic endocarditis with immunotherapy spanning three months. Following a year and three months, he has presented to our institution experiencing acute decompensated heart failure attributable to severe aortic regurgitation （AR），moderate mitral regurgitation （MR），and severe tricuspid regurgitation （TR）．Transesophageal echocardiography revealed aortic valve cusps destruction and anterior mitral valve leaflet vegetation. The potential complications of leukocytoclastic or necrotizing vasculitis due to hypothermic cardiopulmonary bypass in cryoglobulinemia patients were addressed preemptively through preoperative plasmapheresis. During the procedure, tepid core cooling cardiopulmonary bypass at 33℃ and tepid blood cardioplegia solution at 30℃ were employed to mitigate the risk of vasculitis. Urgent aortic valve replacement, mitral vegetation resection, and tricuspid annuloplasty were performed, and the patient was discharged on the 23rd postoperative day without any untoward events.