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Cardiac ochronosis: not so benign.
Pierre Wauthy1, Valérie Seghers, Perrine Mathonet
1Department of Cardiac Surgery, CHU Brugmann, 4, Place A. van Gehuchten, B-1020 Brussels, Belgium.
Summary
Ochronosis complicated an elderly patient's aortic valve replacement due to severe calcification, leading to coronary artery bypass and sternal dehiscence. Chronic corticotherapy for spondylarthrosis contributed to sternal fragility, highlighting risks in cardiac ochronosis patients.
Area of Science:
- Cardiology
- Geriatric Medicine
- Surgical Complications
Background:
- Ochronosis is a rare metabolic disorder that can affect cardiovascular structures.
- Aortic stenosis is a common valvular heart disease in the elderly.
- Chronic corticotherapy is frequently used for inflammatory arthropathies like spondylarthrosis.
Observation:
- A 78-year-old patient with ochronosis presented with symptomatic aortic stenosis.
- The patient underwent aortic valve replacement, which was complicated by severe aortic calcification.
- Massive aortic root hemorrhage necessitated sacrificing and bypassing the right coronary artery.
Findings:
- Surgical complications included a massive aortic root hemorrhage and subsequent sternal dehiscence.
- Sternal dehiscence was attributed to chronic corticotherapy-induced sternal frailty in the context of spondylarthrosis.
- Cardiac ochronosis in the elderly is associated with severe aortic calcification and potential surgical challenges.
Implications:
- This case highlights the significant surgical risks associated with aortic valve replacement in patients with ochronosis and severe aortic calcification.
- Chronic corticotherapy may increase the risk of sternal complications following cardiac surgery.
- Management of elderly patients with ochronosis requires a multidisciplinary approach to mitigate surgical and postoperative risks.
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