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10.5606/tgkdc.dergisi.2012.114
Aortic valve replacement in a patient with factor VII deficiency
Emrah Uğuz, H. Tankut Akay, Atilla Sezgin, Sait Aşlamacı
Departments of 1Cardiovascular Surgery, Medical Faculty of Başkent University, Ankara, Turkey
DOI : 10.5606/tgkdc.dergisi.2012.114
A 69-year-old man who had never experienced episodes
of bleeding was admitted to our hospital with
the complaints of dyspnea, palpitation and orthopnea.
Electrocardiography, echocardiography and laboratory
tests revealed atrial fibrillation, severe aortic stenosis
and elevated INR level (2.18). Coagulation tests due to
isolated INR elevation showed that the activity of factor
VII (FVII) decreased to 9% and the patient was diagnosed
with isolated FVII deficiency. As FVII activity<10%
is associated with high risk of bleeding during surgical
procedures, recombinant FVII (rFVIIa) 40 mcg/kg
was administered intravenous bolus infusion two hours
before surgery. Aortic valve replacement was performed
using a-23 mm bioprosthesis. The activity level of FVII
during anesthesia induction and aortic cross declamping
were 29% and 22%, respectively. Hemostasis was easy to
secure and no extra dose of rFVIIa was given. The patient
did not experience any postoperative problem or severe
bleeding. Warfarin sodium was not administered to the
patient, as he had atrial fibrillation, as well as bioprosthesis
implantation and an INR level of 2.5. At the end of
a-two-year follow-up period, the patient had a good exercise
tolerance without any bleeding or thromboembolic
complication. Factor VII deficiency is an extremely rare
inherited bleeding disorder. Replacement therapy with
rFVIIa with close monitoring of FVII activity is a reliable
way to manage patients with FVII deficiency who are
scheduled to undergo valvular cardiac surgery.
Keywords : Factor VII deficiency; recombinant FVIIa; valve replacement
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