[A case of double-valve replacement in a patient with idiopathic thrombocytopenic purpura]

The aortic and mitral valve replacements were successfully performed in a case with idiopathic thrombocytopenic purpura. High-dose-gamma-globulin therapy and splenectomy had been tried. Neither of them, however could increase thrombocyte. After administration of Danazol treatment, thrombocytes moderately increased. With no expectation for further increase in thrombocytes, it was decided to carry out the open heart surgery with the aid of transfusion of thrombocyte-rich fresh plasma. Haemostasis after cardiopulmonary bypass required much longer time as 3 hours than in usual cases, but being successfully controlled. It has been reported that the effectiveness rate of the high-dose-gamma-globulin therapy ranges from 80 to 90%. Therefore this strategy will be the first choice in a case with ITP requiring open heart surgery. In the event that the strategies, including splenectomy, failed, other means such as Danazol therapy and transfusion of thrombocyte-rich fresh plasma should be considered.