[Aortic valve replacement for quadricuspid aortic valve complicated with idiopathic thrombocytopenic purpura; report of a case].

An 83-year-old woman, who had suffered from idiopathic thrombocytopenic purpura (ITP), was admitted to our hospital because of cardiac heart failure and chest pain. The platelet was 42 x 10(4) in microl. Echocardiography revealed moderate aortic stenosis and regurgitation and left ventricular dysfunction. Preoperatively, we tapered oral steroid and administered high-dose immunoglobulin intravenously. Intraoperatively, we found quadricuspid aortic valve and the rudimentary accessory cusp was located between the right coronary cusp and noncoronary cusp. Aortic valve replacement was performed with bioprosthetic valve. The postoperative course was uneventful. Postoperative echocardiography revealed no perivalvular leakage. Preoperative administration of high-dose immunoglobulin and intraoperative platelet transfusion is very effective to minimize hemorrhagic complication in patients with ITP. We herein report an extremely rare quadricuspid aortic valve complicated with ITP.

[Lethal cholesterol crystal embolization syndrome after operation for abdominal aortic aneurysm].

A 70-year-old man underwent graft replacement for infrarenal abdominal aortic aneurysm, 50 mm in diameter. Postoperatively, he suffered from bilateral lower extremital ischemia. Although he underwent emergency embolectomy of both legs under general anesthesia, severe purplish discoloration of the distal lower extremities developed, and acute renal dysfunction occurred. He was diagnosed with cholesterol crystal embolization syndrome (CCE). We initiated intravenous steroid therapy and infused prostagrandin intraarterially and conducted low density lipoprotein (LDL) apheresis. However, his renal function did not improve and his bilateral toes became necrotic completely. Multiple organ failure rapidly worsened and he died at 38 days after surgery. CCE complicated with severe renal dysfunction is a lethal iatrogenic complication after surgery for abdominal aortic aneurysm. Because the number of CCE is likely to increase in the near future, we should study about CCE more seriously.