The patient had a history of diabetes mellitus (on insulin lispro, 10-12-14-0 U insulin detemir, 0-0-0-10 U per day) with onset at 55 years of age. She had undergone aortic valve replacement (AVR) for aortic valve stenosis 2 years ago. We, herein, present two reports of patients on hemodialysis with rapid worsening of calcified coronary artery disease and subsequent cardiac function.Ī 65-year-old woman presented with dyspnea on exertion. In particular, emergency and concomitant surgeries are some of the significant risk factors of mortality following open-heart surgery in patients on hemodialysis. However, in many patients on dialysis, the clinical symptoms do not match the progression of coronary disease, and predicting the true progress of the medical condition in clinical settings is difficult.Ĭardiac surgeries in patients on hemodialysis have poorer operative outcomes than those in patients not on hemodialysis. Another study suggested that activated platelets may induce leukocyte recruitment in the vascular walls and trigger inflammation, which is mainly observed in the pathogenic mechanisms underlying atherosclerosis. reported that the red blood cell distribution width is an independent predictor of the CAC score. The CAC score has been estimated using the Agatston method with multidetector computed tomography (CT) rapid CAC progression has been associated with multiple risk factors, such as age, uremia, elevated C-reactive protein and phosphorus levels, calcium phosphate products, diabetes mellitus, duration of dialysis, hypertension, high triglyceride levels, and low high-density lipoprotein (HDL) cholesterol concentrations. There are many reports on the coronary artery calcium (CAC) score and its associated factors in patients on hemodialysis. Close outpatient management involving nephrologists and the cardiovascular team is necessary for patients on dialysis. In patients with multiple comorbidities and those who undergo dialysis treatment, calcified lesions in coronary arteries can progress severely and rapidly without any symptoms, including chest pain. The surgeries were successful, and the patients were discharged without any complications. Both patients underwent emergency CABG due to unstable hemodynamics and decreased left ventricular function despite regular dialysis. Cineangiography revealed an increase in the rate of stenosis in the proximal LAD, from 25% (4 years ago) to 90% at admission, in addition to 99% stenosis in proximal LCX and 95% stenosis in the posterolateral branch of LCX. The second case described a 78-year-old man who had undergone surgery for left atrial myxoma 4 years ago and was hospitalized urgently due to dyspnea, chest discomfort, and an LVEF of 44% (Euro II risk score, 40.7% STS risk score, 33.2%). We inserted an intra-aortic balloon pump preoperatively and performed emergency surgery (Euro II risk score, 61.7% Society of Thoracic Surgeons (STS) risk score, 56.3%). Cineangiography revealed an increase in the rate of stenosis in the left main trunk, from 25 to 99% at admission, in addition to 100% occlusion in proximal left anterior descending artery (LAD) and 99% stenosis in the proximal left circumflex artery (LCX). She had moderate mitral regurgitation with right ventricular pressure of 66 mmHg and poor left ventricular function. The first case describes a 65-year-old woman who had undergone aortic valve replacement 2 years ago and was hospitalized urgently, because of a sudden decline in heart function and hypotension. We report two cases of successful coronary artery bypass grafting (CABG) in patients on dialysis with a history of cardiac surgery. Emergency and concomitant surgeries are significant risk factors of mortality following open-heart surgery in patients on hemodialysis. Clinical symptoms of patients on dialysis do not match the signs of coronary disease progression, making the prediction of the true progression of their medical condition in clinical settings difficult.
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