Generic placeholder image

Current Cardiology Reviews

Editor-in-Chief

ISSN (Print): 1573-403X
ISSN (Online): 1875-6557

Case Report

Cardiac Amyloid - A Hidden Contributor to Cardiac Dysfunction Following Cardiac Surgery: Case Report and Literature Review

Author(s): Trevor A. Flood , Scott H. Bradshaw, John P. Veinot and Vidhya Nair*

Volume 16 , Issue 4 , 2020

Page: [350 - 353] Pages: 4

DOI: 10.2174/1573403X16666191220143547

Price: $65

Abstract

We present two patients who underwent cardiac surgery followed by post-operative low cardiac output, diastolic dysfunction and resistance to inotropic support. Despite aggressive medical management, both patients died. At autopsy, the hearts were enlarged and showed previously undiagnosed myocardial and vascular amyloidosis. Occult cardiac amyloidosis is an uncommon, often occult, contributor to post-operative complications post cardiac surgery. Pre-operative or intraoperative myocardial biopsy may be useful in patients with unexplained diastolic dysfunction.

Brief Summary: We present two patients who underwent cardiac surgery followed by low cardiac output, diastolic dysfunction and resistance to inotropic support. Cardiac dysfunction was due to occult amyloidosis. Pre-operative or intra-operative myocardial biopsy may be useful in patients with unexplained diastolic dysfunction. With recent therapy advances, classification and possible treatment of amyloid are possible.

Keywords: Amyloid, cardiomyopathy, pathology, myocardial, surgery, complications.

Graphical Abstract
[1]
Kotani N, Hashimoto H, Muraoka M, Kabara S, Okawa H, Matsuki A. Fatal perioperative myocardial infarction in four patients with cardiac amyloidosis. Anesthesiology 2000; 92(3): 873-5.
[http://dx.doi.org/10.1097/00000542-200003000-00036] [PMID: 10719970]
[2]
Kyle RA, Gertz MA. Cardiac amyloidosis. Int J Cardiol 1990; 28(2): 139-41.
[http://dx.doi.org/10.1016/0167-5273(90)90053-8] [PMID: 2394518]
[3]
Roberts WC, Waller BF. Cardiac amyloidosis causing cardiac dysfunction: Analysis of 54 necropsy patients. Am J Cardiol 1983; 52(1): 137-46.
[http://dx.doi.org/10.1016/0002-9149(83)90084-X] [PMID: 6858901]
[4]
Agha AM, Parwani P, Guha A, et al. Role of cardiovascular imaging for the diagnosis and prognosis of cardiac amyloidosis. Open Heart 2018; 5(2)e000881
[http://dx.doi.org/10.1136/openhrt-2018-000881] [PMID: 30305910]
[5]
Howard S, Jagannathan J, Krajewski K, et al. Multimodality imaging in amyloidosis. Cancer Imaging 2012; 12: 109-17.
[http://dx.doi.org/10.1102/1470-5206.2012.0023] [PMID: 22542865]
[6]
Massoudy P, Szabo AK, Dirsch O, Wienecke H, van de Wal HJCM, Jakob HG. Amyloid of heart and lungs in a patient with low output syndrome after coronary artery bypass grafting. Herz 2003; 28(5): 453-6.
[http://dx.doi.org/10.1007/s00059-003-2359-1] [PMID: 12928745]
[7]
Lee MS, Canan T, Perlowski A, Bhatia R, Jurewitz D, Tobis JM. Causes of death in patients undergoing percutaneous coronary intervention with drug-eluting stents in a real-world setting. J Invasive Cardiol 2009; 21(9): 441-5.
[PMID: 19726814]
[8]
Vrana JA, Gamez JD, Madden BJ, Theis JD, Bergen HR III, Dogan A. Classification of amyloidosis by laser microdissection and mass spectrometry-based proteomic analysis in clinical biopsy specimens. Blood 2009; 114(24): 4957-9.
[http://dx.doi.org/10.1182/blood-2009-07-230722] [PMID: 19797517]
[9]
Holub D, Flodrova P, Pika T, Flodr P, Hajduch M, Dzubak P. Mass spectrometry amyloid typing is reproducible across multiple organ sites. BioMed Res Int 2019; 20193689091
[http://dx.doi.org/10.1155/2019/3689091] [PMID: 30834260]
[10]
Donnelly JP, Hanna M. Cardiac amyloidosis: An update on diagnosis and treatment. Cleve Clin J Med 2017; 84(12): 12-26.
[http://dx.doi.org/10.3949/ccjm.84.s3.02] [PMID: 29257735]
[11]
Leung N, Nasr SH, Sethi S. How I treat amyloidosis: The importance of accurate diagnosis and amyloid typing. Blood 2012; 120(16): 3206-13.
[http://dx.doi.org/10.1182/blood-2012-03-413682] [PMID: 22948045]
[12]
Lane T, Fontana M, Martinez-Naharro A, et al. Natural history, quality of life, and outcome in cardiac transthyretin amyloidosis. Circulation 2019; 140(1): 16-26.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.118.038169] [PMID: 31109193]
[13]
Gertz MA, Mauermann ML, Grogan M, Coelho T. Advances in the treatment of hereditary transthyretin amyloidosis: A review. Brain Behav 2019; 9(9)e01371
[http://dx.doi.org/10.1002/brb3.1371] [PMID: 31368669]
[14]
Rastan AJ, Gummert JF, Lachmann N, et al. Significant value of autopsy for quality management in cardiac surgery. J Thorac Cardiovasc Surg 2005; 129(6): 1292-300.
[http://dx.doi.org/10.1016/j.jtcvs.2004.12.018] [PMID: 15942569]

Rights & Permissions Print Export Cite as
© 2022 Bentham Science Publishers | Privacy Policy