Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue
Coronary artery bypass grafting in a patient with active idiopathic cryoglobulinemia: revisiting the issue
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活动性特发性冷球蛋白血症患者的冠状动脉搭桥术：重新审视这个问题
DOI：
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发表时间：
2016
影响因子：
1
通讯作者：
R. Vij
中科院分区：
文献类型：
--
作者：
H. Fakih;E. Elueze;R. Vij
背景：冷球蛋白血症是一种冷反应性自身免疫性疾病。由于低温体外循环（CPB）的使用，它在心脏手术中具有独特的重要性。在不同的低温水平下激活的cryopulins可在手术过程中引起沉淀，导致可能严重的白细胞破碎性或坏死性血管炎，临床表现为缺血性事件，如皮肤溃疡、肾小球肾炎、关节炎或周围神经病，是最常报告的相关合并症。在这种罕见但独特的情况下，CPB和系统保护的管理需要个性化的规划。我们报告的情况下，病人与活动性冷球蛋白血症谁是术前血浆置换管理。他接受了低温冠状动脉搭桥术，术中和术后没有沉淀和耀斑。我们描述的情况下，一个59岁的白人男性与临床显着的特发性冷球蛋白血症和历史的复发性皮肤病变和脚趾截肢继发于冷暴露。他出现持续2小时的胸痛和新发房颤。心导管检查后，诊断为三支冠状动脉疾病，并计划进行冠状动脉旁路移植术（CABG）。由于在手术过程中爆发的风险很高，患者在搭桥术前预先接受了两次血浆置换治疗。然后，他接受了低温CABG。术前和围手术期过程不明显，没有任何沉淀的临床证据。患者于术后第6天出院，无任何并发症。结论低温冠状动脉搭桥术前血浆置换可预防活动性疾病患者发生致命性冷激相关并发症。
Background Cryoglobulinemia is a cold-reactive autoimmune disease. It is of distinctive importance in cardiac surgery because of the use of hypothermic cardiopulmonary bypass (CPB). Cryoglobulins, which activate at variable levels of hypothermia, can cause precipitation during surgery leading to possibly severe leukocytoclastic or necrotizing vasculitis, clinically manifested as ischemic events, such as cutaneous ulcerations, glomerulonephritis, arthritis, or peripheral neuropathies among the most reported associated comorbidities. Management of CPB and systemic protection in this rare but unique scenario requires individualized planning. We report the case of a patient with active cryoglobulinemia who was preoperatively managed with plasmapheresis. He underwent hypothermic coronary bypass with no precipitation and flare during and after surgery. Case presentation We describe the case of a 59-year-old Caucasian male with clinically significant idiopathic cryoglobulinemia and history of recurrent skin lesions and toe amputations secondary to cold exposure. He presented with 2-h duration of chest pain and new onset atrial fibrillation. After cardiac catheterization, a diagnosis of three-vessel coronary artery disease was established and coronary artery bypass grafting (CABG) was scheduled. Because of a high risk of flare-up during surgery, the patient was preemptively treated with two sessions of plasmapheresis before bypass. He then underwent hypothermic CABG. The pre- and perioperative course was unremarkable without any clinical evidence of precipitation. The patient was discharged on day 6 postoperatively without any complications. Conclusion Preoperative plasmapheresis before hypothermic coronary bypass can prevent fatal cryoglobulinemia-related complications in patients with active disease.
低温麻醉减弱术后蛋白水解作用。
影响因子：
9
作者：
Johnson,DJ;Brooks,DC;Pressler,VM;Hulton,NR;Colpoys,MF;Smith,RJ;Wilmore,DW
通讯作者：
Wilmore,DW