CASE PRESENTATION: We report a case of emergency aortic arch replacement surgery for acute type A
aortic dissection in a 57-year-old Japanese man. A blood test prior to the surgery showed coagulopathy, a platelet count of 117 × 109/L, a prothrombin time-international normalized ratio of 1.78, an activated partial thromboplastin time of 69.7 seconds, and
fibrinogen < 50 mg/dl. A smaller-than-usual dose of
heparin (8000 IU) was administered because the patient's activated clotting time was extremely prolonged (> 999 seconds). After the
heparin administration, the activated clotting time, measured every 30-60 minutes, remained unchanged (> 999 seconds); therefore, additional
heparin was not administered during the surgery, and there was no clinical problem during
cardiopulmonary bypass. However, a diagnosis of global
cerebral infarction was made on the first postoperative day. An additional blood coagulation test performed on postoperative day 9 revealed
factor XII deficiency (8.0%). Regarding the reason that global
cerebral infarction occurred in the present case, two reasons were considered: One was
factor XII deficiency itself, and the other was low-dose
heparin administration during the
cardiopulmonary bypass due to excessively prolonged activated clotting time caused by
factor XII deficiency.
CONCLUSIONS: