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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

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 valv...

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Autores principales: Liang, Shichu, Guan, Mingjing, Liu, Zhiyue, Ruan, Xiaomiao, Huang, He, Zhong, Hui
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Taylor & Francis 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561572/
https://www.ncbi.nlm.nih.gov/pubmed/37799073
http://dx.doi.org/10.1080/0886022X.2023.2264401
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author Liang, Shichu
Guan, Mingjing
Liu, Zhiyue
Ruan, Xiaomiao
Huang, He
Zhong, Hui
author_facet Liang, Shichu
Guan, Mingjing
Liu, Zhiyue
Ruan, Xiaomiao
Huang, He
Zhong, Hui
author_sort Liang, Shichu
collection PubMed
description 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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spelling pubmed-105615722023-10-10 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 Ren Fail Brief Report 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. Taylor & Francis 2023-10-06 /pmc/articles/PMC10561572/ /pubmed/37799073 http://dx.doi.org/10.1080/0886022X.2023.2264401 Text en © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. https://creativecommons.org/licenses/by-nc/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ), which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent.
spellingShingle Brief Report
Liang, Shichu
Guan, Mingjing
Liu, Zhiyue
Ruan, Xiaomiao
Huang, He
Zhong, Hui
Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title_full Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title_fullStr Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title_full_unstemmed Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title_short Sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
title_sort sailing between scylla and charybdis—anticoagulation dilemma in a patient with calciphylaxis and mechanical cardiac valve replacement: a case report and literature review
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10561572/
https://www.ncbi.nlm.nih.gov/pubmed/37799073
http://dx.doi.org/10.1080/0886022X.2023.2264401
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