Investigation of Mitral Valve Replacement in a Patient with Mitral Valve Stenosis Who Complicated with Myelodysplastic Syndrome and Left Atrial Thrombosis

Abstract

Patients with myelodysplastic syndrome (MDS) most commonly have refractory anemia accompanied by various degrees of granulocytopenia and thrombocytopenia. At the time of cardiac surgery, both major infections and bleeding are severe complications in patients with pancytopenia due to MDS. However, there were very few patients with MDS who had undergone open-heart surgery. We reported a case of mitral valve replacement in a patient with MDS. A 68-year-old man with valvular heart disease and MDS, with a platelet count of 1.9×10⁴/mm³, underwent successful mitral valve replacement. The mitral valve was replaced by an SJM 25 A prosthesis after resection of left atrial thrombosis using cardiopulmonary bypass. Platelets were transfused after the bypass. Perioperative hemorrhage was moderate and postoperative course was uneventful. We evaluated platelet function by Sonoclot coagulation and a platelet function analyzer. We did not need a large amount of transfusion of red blood cells and platelets, and prevented major bleeding and severe wound infections in the acute postoperative state.