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Sailing between scylla and charybdis-anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review.
Liang, Shichu; Guan, Mingjing; Liu, Zhiyue; Ruan, Xiaomiao; Huang, He; Zhong, Hui.
Afiliação
  • Liang S; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
  • Guan M; Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
  • Liu Z; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
  • Ruan X; Department of Ultrasound, West China Hospital, Sichuan University, Chengdu, China.
  • Huang H; Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China.
  • Zhong H; Department of Nephrology, West China Hospital, Sichuan University, Chengdu, China.
Ren Fail ; 45(2): 2264401, 2023.
Article em En | MEDLINE | ID: mdl-37799073
ABSTRACT
Calciphylaxis is a rare and life-threatening condition in patients with end-stage kidney disease (ESKD). In this case report, we reported a 72-year-old female who had undergone aortic and mitral mechanical valve replacement 22 years ago due to rheumatic aortic and mitral stenosis. Following the valve replacement, she initiated warfarin treatment. Five years ago, she received a diagnosis of uremia and has since been undergoing regular hemodialysis. Ten months prior to her current admission, she experienced excruciating pain and was diagnosed with calciphylaxis. Additionally, an electrocardiogram revealed atrial fibrillation, while echocardiography indicated that the aortic and mitral mechanical valves were appropriately positioned, with normal perivalvular surroundings and good valve leaflet activity. No noticeable thrombosis was observed in the left atrium or left atrial appendage. Color Doppler imaging showed moderate stenosis in the lower extremity arteries, with no venous thromboembolism present. Extensive eggshell-like calcification within the arterial media was detected. The patient was managed with regular hemodialysis, symptomatic treatments (including anticoagulation and analgesia), and sodium thiosulfate. Unfortunately, symptomatic management provided limited relief, and during the one-month follow-up period, the patient passed away due to septic shock. Currently, there is insufficient conclusive evidence regarding alternative influential anticoagulants or appropriate prosthetic valve selection. For individuals with ESKD receiving maintenance hemodialysis, early identification, diagnosis, and treatment of calciphylaxis are of paramount importance.
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Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Fibrilação Atrial / Calciofilaxia / Falência Renal Crônica Limite: Aged / Female / Humans Idioma: En Revista: Ren Fail Assunto da revista: NEFROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: China

Texto completo: 1 Bases de dados: MEDLINE Assunto principal: Fibrilação Atrial / Calciofilaxia / Falência Renal Crônica Limite: Aged / Female / Humans Idioma: En Revista: Ren Fail Assunto da revista: NEFROLOGIA Ano de publicação: 2023 Tipo de documento: Article País de afiliação: China