A Case of High-Risk Myelodysplastic Syndrome Revealed After Emergent Aortic Surgery

The outcomes of cardiac surgery in patients with hematologic disorders are significantly worse. However, details of the clinical course of each hematologic disease remain unclear. Myelodysplastic syndrome (MDS) presents with progressive pancytopenia that has the risk of infection, hemorrhage, and transformation to acute myelogenous leukemia. A 65-year-old woman who had a history of surgery for Stanford type A acute aortic dissection presented rapidly decreasing platelets and the appearance of erythroblasts in peripheral blood. A bone marrow biopsy was performed. The day after the biopsy, an impending rupture of the pseudoaneurysm at the graft anastomosis site was found accidentally by computed tomography. Although she underwent aortic root replacement, she had recurrent thrombocytopenia and anemia, along with unexpected bleeding complications after surgery. After she was diagnosed with high-risk MDS, the management was challenging, including the decision of the indication for blood transfusion and treatments for some complications. Ultimately, she died due to infection. This report provides valuable insights into the detailed postoperative course of cardiac surgery in a patient with high-risk MDS.