Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học Wertheim cung cấp cho các bạn kiến thức về ngành y đề tài: Redo-redo aortic root replacement with a mechanical valved conduit in a patient with von Willebrand’s disease: Case report. | Shaikhrezai et al. Journal of Cardiothoracic Surgery 2010 5 59 http content 5 1 59 JOTS JOURNAL OF CARDIOTHORACIC SURGERY CASE REPORT Open Access Redo-redo aortic root replacement with a mechanical valved conduit in a patient with von Willebrand s disease Case report 1 3 3 2 1 Kasra Shaikhrezai Usman Bashir Sheena Millar Julia Anderson Edward T Brackenbury Abstract A 40 year-old female with a history of cardiac surgery for congenital aortic valve stenosis and von Willebrand s disease VWD presented with increasing shortness of breath due to mixed aortic valve dysfunction. With a paucity of such cases in the literature we describe the successful outcome of a patient with VWD who underwent elective redo-redo aortic root replacement with a mechanical valved conduit. She was given a three-month trial of warfarin pre-operatively to evaluate the extent of bleeding risk. Her post-operative course was uneventful and she was discharged home after six days. Background VWD is an autosomal dominant bleeding diathesis with an incidence of 2-3 in the general population. The disease is characterised by a partial quantitative decrease of qualitatively normal von Willebrand factor VWF and Factor VIII FVIII 1 . Recently researchers have reported that the increased shear stress resultant from a stenotic valve causes mechanical disruption and cleavage of VWF by ADAMTS-13 a metalloprotease enzyme that cleaves VWF during passage through a stenotic orifice affecting the molecular conformation of large VWF multimers 2 3 . There is a small and evolving literature regarding the management of patients with VWD undergoing cardiac surgery. Our patient received a trial of warfarin preoperatively which is a challenging decision in the context of VWD disease. We performed Redo-redo aortic valve replacement with a mechanical valved conduit. The surgical procedure accompanied by haematologist and anaesthetist input is discussed as well. Case presentation A 40 year-old .
