A successful case report of composite graft and total aortic arch replacement in a patient with chronic idiopathic thrombocytopenic purpura (ITP)

: A successful composite graft and total aortic arch replacement for aortic valvular disease and thoracic aneurysm from the ascending aorta to the distal aortic arch with ITP is reported in a 68-year-old male. For seven years the ITP was treated with corticosteroids, the platelet count was 5.6 x 10(4)/mm3 on admission. At operation a low dose of aprotinin was administered before cardiopulmonary bypass and two packs of platelet were transfused after that. The platelet count was dramatically increased to 13 x 10(4)/mm3 after surgery from 1.8 x 10(4)/mm3 at the end of cardiopulmonary bypass without preoperative treatment of high-dose gamma-globulin. Perioperative bleeding was moderate and postoperative course was uneventful. This is first case of extended graft replacement for thoracic aneurysm associated with ITP.