Multiple digital gangrene after hypothermic open heart surgery in a scleroderma patient: case report

The case of a 40 years old female who suffers from scleroderma and Raynaud's Phenomenon and who underwent open heart surgery for mitral valve replacement with a bi=leaflet mechanical valve and tricuspid valve annuloplasty with a Puig Massana Ring and developed post operative irreversible bilateral symmetric digital gangrene, reversible acute renal failure and temporary complete third degree atrioventricular block is presented. Systemic hypothermia during cardiopulmonary bypass has activated the cryoglobulins with their precipitation in the small digital and renal arteriolar vessels and eventually capillary and arteriolar vasopasm was induced by the hypothermia which led to consequent ischemia and digital gangrene. The picture of vasopasm, acute renal failure and complete third degree block reflect acute exacerbation of scleroderma after hypothermic open heart surgery