Undiagnosed Type IIIc Gaucher Disease in a Child With Aortic and Mitral Valve Calcification: Perioperative Complications After Cardiac Surgery

Stanford Department of Anesthesia, Lucile Packard Children's Hospital, Stanford, CA 94305, USA.
Journal of cardiothoracic and vascular anesthesia (Impact Factor: 1.46). 08/2009; 24(3):471-4. DOI: 10.1053/j.jvca.2009.05.006
Source: PubMed
4 Reads
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Bleeding manifestations are common in Gaucher disease patients. Although usually attributed to thrombocytopenia, some patients with relatively high platelet counts and normal coagulation tests have hemorrhagic phenomena. To investigate whether perturbed platelet function could explain these bleeding manifestations we performed platelet aggregation tests on 32 type I adult Gaucher patients who were not severely thrombocytopenic (platelet counts >50 x 10(9)/L). Seven patients (22%) had abnormal platelet aggregation. In five, platelet aggregation was markedly reduced in response to collagen and ADP and virtually absent in response to epinephrine, whereas two patients had isolated severely impaired epinephrine-induced aggregation. In one patient platelet aggregation markedly improved following one year of enzyme replacement therapy. Incubating normal platelets with high concentrations of glucocerebroside did not impair their ability to aggregate, suggesting that plasma glucocerebroside does not directly interfere with platelet function. Platelet dysfunction is a hitherto unrecognised, relatively common cause of excessive bleeding in Gaucher patients.
    American Journal of Hematology 06/1999; 61(2):103-6. DOI:10.1002/(SICI)1096-8652(199906)61:2<103::AID-AJH5>3.0.CO;2-V · 3.80 Impact Factor
  • European Journal of Anaesthesiology 04/2006; 23(3):265-6. DOI:10.1017/S026502150524228X · 2.94 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Gaucher's disease is the most prevalent sphingolipid storage disease, characterised by substantial genetic and phenotypic variability. Cardiac manifestations are rare. We report 12 Arab Gaucher's disease patients, 2-20 years of age, who presented with oculomotor apraxia but only slight classic signs of the disease. All but the youngest had calcifications of the aortic or mitral valves or both. All these patients were homozygous for the rare point mutation D409H (1342C). Valvular calcifications increased with age and showed progression during 2 years of follow-up. Two of the oldest patients underwent aortic valve replacement, and one sibling had died suddenly at age 16, before this study, Corneal opacities were another common feature. The potentially fatal course of this Gaucher's disease variant, and the availability of a reliable PCR-based method for heterozygote detection, mean that population screening and genetic counselling in the geographic area at risk are important. Affected individuals should be closely monitored by echocardiography to gauge the need for valve replacement. The potential of enzyme replacement to prevent these cardiac complications cannot be ascertained at present, because of the high cost of therapy.
    The Lancet 11/1995; 346(8981):1000-3. DOI:10.1016/S0140-6736(95)91688-1 · 45.22 Impact Factor
Show more