Successful treatment of thrombotic thrombocytopenic purpura associated with mitral valve replacement

Thrombotic thrombocytopenic purpura (TTP) is a rare hematologic syndrome. It is a multisystem disorder characterized by microangiopathic hemolytic anemia and thrombocytopenia and may be accompanied by fever and renal or neurologic abnormalities (1,2). Most adult patients acquire (3) the disease as a result of autoantibodies against ADAMTS13 (i.e., idiopathic TTP), or it is observed in association with collagen vascular disease, bone marrow transplantation, systemic sclerosis, infections, polymyositis, pregnancy, or drug treatment, including cyclosporine, tacrolimus, ticlopidine, and antineoplastic agents (i.e., nonidiopathic TTP) (1,4). However, TTP associated with mitral valve replacement surgery has not been reported. In this paper, we describe a case of a 41-year-old female who developed acute TTP after mitral valve replacement surgery. The patient was treated with plasma exchange (PE) and recovered following an uneventful course.