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An unexpected mortality following cardiac surgery: a post-mortem diagnosis of cardiac amyloidosis

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Abstract

Amyloidosis is a rare systemic disease that is notoriously difficult to diagnose early. Cardiac involvement is associated with a poor prognosis. We present the case of a 72-year-old gentleman who underwent elective coronary artery bypass grafting and mitral valve repair. While initially making a good post-operative recovery, a sudden deterioration on post-operative day 3 led to an unexpected mortality. Post-mortem examination demonstrated previously undiagnosed severe systemic amyloidosis, which particularly affected his heart, due to underlying multiple myeloma. It is important to emphasise that due to the absence of the typical findings on routine pre-operative investigations suggestive of cardiac amyloidosis in this patient, cardiac surgeons should be aware that symptoms inconsistent with angiography findings should prompt consideration of amyloidosis. Diagnostic tools including cardiac MRI and ultimately endomyocardial biopsy could then facilitate earlier recognition of this enigmatic disease process.

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Acknowledgments

We would like to thank Professor Peter Hamilton for his assistance in the production of the histopathology images.

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Authors and Affiliations

  1. Department of Cardiac Surgery, The Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK

    Gerard J. Fitzmaurice & Alastair N. J. Graham

  2. Department of Pathology, The Royal Victoria Hospital, Grosvenor Road, Belfast, BT12 6BA, Northern Ireland, UK

    Victoria Wishart

  3. 10 Lanyon Manor, 2-4 Eglantine Place, Belfast, BT9 6EY, Northern Ireland, UK

    Gerard J. Fitzmaurice

Authors
  1. Gerard J. Fitzmaurice
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  2. Victoria Wishart
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  3. Alastair N. J. Graham
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Correspondence to Gerard J. Fitzmaurice.

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Fitzmaurice, G.J., Wishart, V. & Graham, A.N.J. An unexpected mortality following cardiac surgery: a post-mortem diagnosis of cardiac amyloidosis. Gen Thorac Cardiovasc Surg 61, 417–421 (2013). https://doi.org/10.1007/s11748-012-0164-6

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  • DOI: https://doi.org/10.1007/s11748-012-0164-6

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