[A case report: mitral valve replacement for the patient with essential thrombocythemia]

A 62-year-old man with heart murmur and recent cerebral thrombosis was admitted to our hospital. Examination of his heart revealed mitral stenosis and hematological study confirmed the diagnosis of essential thrombocytosis (ET). After 1100 ml pre-operative phlebotomy, mitral valve replacement with a 29 mm Björk-Shiley prosthesis was performed utilizing routine cardio-pulmonary bypass using only his prestored blood and moderate hypothermia. We had no difficulty in hemostasis at the operation. Acute gastric bleeding began suddenly as much as 1500 ml on the 4th postoperative day. As medical care was in vain, emergent distal gastrectomy was performed. As we used urokinase for fear of thrombosed valve formation, residual gastric bleeding was continued on. Then, we began to use Gabexate-Mesilate (FOY) instead of urokinase. Retrospectively, Gabexate-Mesilate was very useful drug for preventing the left atrium and prosthesis from thrombo-formation until the start of oral intake of Warfarin and Busulfan. To our knowledge, this would be the first case report of open-heart valve replacement surgery in a ET patient in Japan.