Abstrakt
Cardiac amyloidosis is a complex pathology with poor prognosis since the onset of clinical manifestation. Should this disease be addressed by cardiac surgery the only therapeutic option is heart transplantation which however remains controversial in view of postoperative results and amyloidosis involvement of the graft.
In opposite clinical paradigm, undiagnosed cardiac amyloidosis is a feared event in routine cardiac surgery. Cardiac surgery procedure - with or without cardiopulmonary bypass - is a malignant stressor triggering almost intractable hear failure.
Cardiac surgery in patients with cardiac amyloidosis should be strictly avoided. Due to its complex nature, multifaceted clinical symptoms and relatively rare occurence this diagnosis is however methodologically difficult to be distinguished properly in current era large volume cardiac surgery practice.
Standardized diagnostic imaging protocol poses risk of bias in favour of more common clinical diagnoses. The signs of cardiac amyloidosis may mimick signs of other cardiac involvement or it may be a concomitant pathology.
Thus different uneasy patterns may occur in patients referred for valve or coronary artery surgery. The pitfalls will be discussed on few case reports.